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9 Multiple Sclerosis Nursing Care


. 70% of patients lead active. productive lives with prolonged remissions. MS is characterized by exacerbations and remissions. However. disabling some patients by early adulthood or causing death within months of onset. sporadic patches of demyelination throughout the central nervous system induce widely disseminated and varied neurologic dysfunction. The prognosis varies. MS is a progressive disease caused by demyelination of the white matter of the brain and spinal cord. MS is a major cause of chronic disability in young adults. In this disease. MS may progress rapidly . 391  Facebook269  Twitter6  17  0  0  7  72  20 Multiple sclerosis (MS) is the most common of the demyelinating disorders and the predominant CNS disease among young adults.

With that. It affects more women than men.  Participate in recommended treatment program.  Identify alternatives to help maintain desired activity level. pregnancy or acute respiratory tract infections have been known to precede the onset of this illness. fatigue. MS usually begins between ages 20 and 40.The exact cause of MS is unknown. Contents [show] Nursing Care Plans The goal of treatment is to shorten exacerbations and relieve neurologic deficits so that the patient can resume a normal lifestyle. here are 9 multiple sclerosis nursing care plans (NCP). increased energy requirements to perform activities  Psychological/emotional demands  Pain/discomfort  Medication side effects Possibly evidenced by  Verbalization of overwhelming lack of energy  Inability to maintain usual routines. but current theories suggest a slow-acting or latent viral infection and an autoimmune response. Fatigue May be related to  Decreased energy production. . decreased performance  Impaired ability to concentrate. disinterest in surroundings  Increase in physical complaints Desired Outcomes  Identify risk factors and individual actions affecting fatigue. 1. Other theories suggests that environmental and genetic factors may also be linked to MS. overworking. Stress.  Report improved sense of energy.

Determine need for walking aids. Reduces fatigue. individual may display poor judgment about ability to safely engage in activity. Investigate use of cooling vest. aggravation of muscle weakness Assist with physical therapy. insomnia. has a disproportiona impact on ADLs. However. time of day. Some patients report lessening of fatigue with stabilization of body temperature. Studies indicate that the fatigue encountered by patients with MS occurs with expenditure of minimal energy. is more frequent a severe than “normal” fatigue. Accept when patient is unable to do activities. Ability can vary from moment to moment. as well as safety. Schedule ADLs in the morning if appropriate.Nursing Interventions Rationale Note and accept presence of fatigue. use of medications. Plan care consistent rest periods between activities. inadequate food intake. Reduces fatigue and promotes sense of wellness. and may show no direct relationship between fatigue severity and patient’s clinical neurological status. Nonjudgmental acceptance of patient’s evaluation day-to-day variations in capabilities provides opportunity to promote independence while supporting fluctuations in level of required care. Fatigue commonly worsens in late afternoon (whe body temperature rises). Provides opportunity to problem-solve to maintain improve mobility. Review safety considerations. Increase patient comfort with massages and relaxing baths. walkers. has a slower recovery time. enhancing independence and comfort. Stress need for stopping exercise or activity just short of fatigue. Pushing self beyond individual physical limits can result in excessive or prolonged fatigue and . Identify and review factors affecting ability to be active: temperature extremes. Fatigue is the most persistent and common symptom of MS. Encourage afternoon nap. Mobility aids can decrease fatigue. Provide braces. or wheelchairs.

lamotrigine (Lamictal) Used to treat neurogenic pain and sudden intermittent spasms related to spinal cord irritation . and insomnia. nortriptyline (Pamelor) Useful in treating emotional lability. paresthesias of hands and feet. Recommend participation in groups involved in fitness or exercise and/or the Multiple Sclerosis Society. Positive antiviral dru effect in 30%–50% of patients. restlessness. Investigate appropriateness of obtaining a service dog. insomnia. Sertraline (Zoloft). patient can become very adept at knowing limitations. gabapentin (Neurontin). Can help patient to stay motivated to remain active within the limits of the disability or condition. and “energizing” patient (especially when depression i a factor) and when patient is free of anticholinergic side effects. Tricyclic antidepressants: amitriptyline (Elavil). Use may be limited by side effects of increased spasticity.Nursing Interventions Rationale discouragement. fluoxetine (Prozac) Antidepressants useful in lifting mood. They can also assist in energy conservation by carrying items in “saddle” bags an retrieving or performing tasks. Anticonvulsants: carbamazepine (Tegretol). pemoline (Cylert) Useful in treatment of fatigue. neurogenic pa and associated sleep disorders to enhance willingness to be more active. Administer medications as indicated: Amantadine (Symmetrel). Methylphenidate (Ritalin). In time. Grou activities need to be selected carefully to meet patient’s needs and prevent discouragement or anxiety. modafinil (Provigil) CNS stimulants that may reduce fatigue but may also cause side effects of nervousness. Service dogs can increase patient’s level of independence.

(Copaxone chemically resembles a component of myelin and may act as a decoy. azathioprine (Imuran).Nursing Interventions Rationale Steroids: prednisone (Deltasone). interferon [beta]-1B (Betaseron). reduce the frequency of relapse. glatiramer (Copaxone). Current research indicates early treatment with drugs that reduce inflammatio and lesion formation may limit permanent damage Therapy of choice is “A. Prepare for plasma exchange treatment as indicated. Research suggests that individuals experiencing severe exacerbations not responding to standard therapy may benefit from a course of plasma exchange 2. methotrexate (Mexate). Immuno-modulating agents: cyclo phosphamide (Cytoxan). Note: Long-term therapy seems to have little effect on progression of symptoms. C” drugs: Avonex. and Copaxone. Self-care Deficit May be related to . Rebif). Vitamin B Supports nerve-cell replication. Interferon [beta]-1B (Betaseron) has been approve for use by ambulatory patients with remitting relapsing MS and is the first drug found to alter the course of the disease. and may increase sense of well-being and energy level. and promote remission. enhances metabo functions. Therapeutic benefits have been reported in patients at all stages of disability with reduction in both steroid use and hospital days. B. Betaseron. mitoxantrone (Novantrone). methyl-prednisolone (Solu-Medrol) May be used during acute exacerbations to reduce and prevent edema formation at the sclerotic plaques. dexamethasone (Decadron). diverting immune cells away from myelin target.) Note: Novantrone may be used if other medications not effective but is contraindicated in patients with primary progressive MS. interferon [beta]-1A (Avonex. May be used to treat acute relapses.

Patient’s quality of life is enhanced when desires and likes are considered in daily activities. in fa . Provides information to develop plan of care for rehabilitation. Fatigue experienced by patients with MS can be very debilitating and greatly impact ability to participate in ADLs. decreased strength and endurance. Note presence of fatigue. tremors  Pain. inability to perform tasks of self-care.  Perform self-care activities within level of own ability.  Demonstrate techniques/lifestyle changes to meet self-care needs. Promotes independence and sense of control. leading to conflict and the belief that the patient is “manipulative” when. Do not rush patient. poor personal hygiene Desired Outcomes  Identify individual areas of weakness/needs. ma decrease feelings of helplessness. Encourage patient to perform self-care to the maximum of ability as defined by patient.  Identify personal/community resources that provide assistance. Neuromuscular/perceptual impairment. Encourage patient input in planning schedule. The subjective nature of repo of fatigue can be misinterpreted by healthcare providers and family. Assist according to degree of disability. intolerance to activity. allow as much autonomy as possible. discomfort. Note: Motor symptoms are less likel to improve than sensory ones. motor impairment. Nursing Interventions Rationale Determine current activity level and physical condition. Assess degree of functional impairment using 0–4 scale. Participation in own care can ease the frustration over loss of independence. fatigue  Memory loss  Depression Possibly evidenced by  Frustration.

Useful in identifying devices and/or equipment to . shaving. such as sacrum. Provide massage and active or passive ROM exercises on a regular schedule. ankles. and splints and maintenance of proper body alignment. Encourage use of splints or footboards as indicated. Helps maintain muscle to and strength and joint mobility. Provides for adequate intake and enhances patient’s feelings of independence or self-esteem. Encourage stretching and toning exercises and use of medications. Reposition frequently when patient is immobile (bed or chair bound). Patients with MS expend a great deal of energy to complete ADLs. skin. when indicated. Prevents problems associated with muscle dysfunction and disuse. Provide assistive devices and aids as indicated: shower chair. Caregiver’s example can set a matter-of-fact tone for acceptance of handling mundane needs that many be embarrassing to patient and repugnant to SO. Encourage scheduling activities early in the day or during the time when energy level is best. increasing the risk of fatigue. and decreases risk of loss of calcium from bones. Reduces fatigue. Decreased motor skills and spasticity may interfer with ability to manage even simple activities. Minimizes flexor spasms at knee and hips. Consult with physical and/or occupational therapist. prevents skin breakdown. Helps decrease spasticity and its effects. elevated toilet seat with arm supports. and hair. Allot sufficient time to perform tasks. Provide skin care to pressure points. Reduces pressure on susceptible areas. and display patience when movements are slow. Position properly and encourage to sleep prone as tolerated. Problem-solve ways to meet nutritional and fluid needs. mouth care. and elbows. Anticipate hygienic needs and calmly assist as necessary with care of nails. cold packs. enhancing participation in selfcare. whic often progresses through the day.Nursing Interventions Rationale this may not be the case.

A variety of medications are used to reduce spasticity. Note: Adverse effects may be increased muscle weakness. allowing patient to be more mobile. cyclobenzaprine (Flexeril). 3. Short duration of action requires care individualizing of dosage to maximize therapeutic effect. Reduces dizziness. dantrolene (Dantrium). Therefore. carbamazepine (Tegretol). Low Self-Esteem May be related to  Change in structure/function  Disruption in how patient perceives own body  Role reversal. Meclizine (Antivert). loss o muscle tone. promotin muscle relaxation. clonazepam (Klonopin). improve motor functioning prevent and reduce muscular atrophy and contractures. baclofen (Lioresal). Administer medications as indicated: Tizanidine (Zanaflex). and liver toxicity. Enhance mobility and maintenance of activity. Diazepam (Valium). and inhibiting reflexes at the spinal nerve root level. bu use with caution because both drugs have similar side effects. Tizanidine (Zanaflex) may have an additive effect with baclofen (Lioresal). scopolamine patches (Transderm-Scop). gabapentin (Neurontin. promoting independence and increasing sense of self-worth. The mechanisms are not well understoo and responses vary in each person.Nursing Interventions Rationale relieve spastic muscles. Newer drugs used for reducing spasticity. it may take a period of medication trials to discover what provides the most effective relief of muscle spasticity and associated pain. dependence Possibly evidenced by .

withdrawal. Review information about course of disease. Note withdrawn behaviors and use of denial or over concern with body and disease process. feelings o helplessness. Promotes a sense of well-being for patient. but prolonged. Conveys an attitude of caring and develops a sens of trust between patient and caregiver in which patient is free to express fears of rejection. Confronting patient with reality of situation may result in increased anxiety and lessened ability to cope with changed self-concept/role. Nature of the disease leads to ongoing losses and changes in all aspects of life.  View self as a capable person. may prevent dealing appropriately with reality and may lead to ineffective coping. blocking resolution o grieving process. Acknowledge reality of grieving process related to actual or perceived changes. purpose.  Recognize and incorporate changes in self-concept/role without negating self-esteem. loss of previous functioning and/or appearance. allowing patient to deal with information in own time and way. When patient learns about disease and becomes . discussing fears and concerns. Confusion about sense of self. direction in life  Denial. Support use of defense mechanisms. Help patient deal realistically with feelings of anger and sadness.  Develop realistic plans for adapting to role changes. Nursing Interventions Rationale Establish and maintain a therapeutic nurse-patient relationship. anger  Negative/self-destructive behavior  Use of ineffective coping methods  Change in self/other’s perception of role/physical capacity to resume role Desired Outcomes  Verbalize realistic view and acceptance of body as it is.  Participate in and assume responsibility for meeting own needs. powerlessness about changes that may occur. Initially may be a normal protective response.

Physical and psychological changes often create stressors within the relationship. provides reference source fo future use. affecting usual roles and expectations. prognosis. Problem-solve ways to deal with these feelings. progressively debilitating incurable disease is a difficult emotional adjustme In addition. arousal. expressions of suicidal ideation (evaluate on a scale of 1–10). A depressed individual may believe that suicide is the best way to deal wi what is happening. or issues secondary gain may interfere with progress and ability to manage situation. dinoprostone [Prostin E2]) or other avenues of improving sexual relationship. Relieves anxiety and assists with efforts to manag unexpected emotional displays. Adapting to a long-term.” reduces fear of the unknown. spasticity. Note changes in relationship. aware that own behavior (including feeling hopefu maintaining a positive attitude) can significantly improve general well-being and daily functioning. further impairing selfconcept. patient may feel more in control. Note presence of depression and impaired thought processes.Nursing Interventions Rationale possibility of remissions. Helps patient stay in the “here and now. and changes in sensation. Discuss use of medications and adjuncts to improve sexual function. Patient and partner may want to explore trial of medications (papaverine [Pavabid]. cognitive impairment may affect adaptation to life changes. Assess interaction between patient and SO. Consult with occupational therapist/ rehabilitation Identifying assistive devices and/or equipment . Note: Some patients may never have remission. Explain that labile emotions are not unusual. Provide open environment for patient and SO to discuss concerns about sexuality. including management of fatigue. enhancing sense self-esteem. SO may unconsciously or consciously reinforce negative attitudes and beliefs of patient. Provide accurate verbal and written information about what is happening and discuss with patient/SO.

unpredictability of disease  Lifestyle of helplessness Possibly evidenced by  Verbal expressions of having no control or influence over situation  Depression over physical deterioration that occurs despite patient compliance with regimen  Nonparticipation in care or decision making when opportunities are provided  Passivity. 4. Powerlessness/Hopelessness Nursing Diagnosis  Powerlessness  Hopelessness May be related to  Illness-related regimen. enhancing sense of well-being and viewing self as a capable individual.  Participate/monitor and control own self-care and ADLs within limits of the individual situation. decreased verbalization/affect  Verbal cues  Lack of involvement in care/passively allowing care  Isolating behaviors/social withdrawal Desired Outcomes  Identify and verbalize feelings. enhances level of overall function and participation in activities.  Use coping mechanisms to counteract feelings of hopelessness.Nursing Interventions Rationale team.  Identify areas over which individual has control. .

setting up agreed-on routines for meeting identified needs. . Acknowledge reality of situation. Patient who has assumed responsibility in life previously tends to do the same during difficult tim of exacerbation of illness. having a voice in wh is desired or not. Determine degree of mastery patient has exhibited in life to the present. List things that can or cannot be controlled. Helps deal with manipulative behavior. However. Note locus of control. when patie feels powerless and not listened to. Encourage patient to assume control over as much of own care as possible. affects how patient handles life situation. Staying active and interacting with others countera feelings of helplessness. Assist patient to identify factors that are under own control. taking a look at the possibilities for care as condition changes. Discuss plans for the future. remissions may occur. hope for some quality of life should be encouraged. Even when unable to do much physical care. that he or she is powerless to change what is happening. Discuss needs openly with patient/SO. Patient may say statements of despair. Suggest visiting alternative care facilities. and because the future cannot be predicted. if locus of control has been focused outward.Nursing Interventions Rationale Note behaviors indicative of powerlessness or hopelessness. Although the prognosis may be discouraging. patient has a sense of control over own circumstances. Additionally. at the same time expressing hope for patient. Knowing and accepting what is beyond individual control can reduce helpless or acting out behavior promote focusing on areas individual can control. The degree to which patient believes own situation is hopeless. When options are considered and plans are made for any eventuality. Encourage and assist patient to identify activities he or she would like to be involved in within the limits of his or her abilities. research is ongoing and new treatment options are being initiated. patient may blame others and not take control over own circumstances. individual can help plan care.

as the problem has not occurred and nursing interventions are directed at prevention. A risk diagnosis is not evidenced by signs and symptoms. Identify community resources. Risk for Ineffective Coping Risk factors may include  Physiological changes (cerebral and spinal lesions)  Psychological conflicts. Desired Outcomes  Recognize relationship between disease process (cerebral lesions) and emotional responses. Refer to vocational rehabilitation as indicated. short-term memory loss. . anxiety.Nursing Interventions Rationale Incorporate patient’s daily routine into home care schedule or hospital stay. inadequate support systems  Multiple life changes  Inadequate coping methods Possibly evidenced by  Not applicable. Maintains sense of control and self-determination and independence. Participation in structured activities can reduce sense of isolation and may enhance feeling of self worth.  Demonstrate behaviors/lifestyle changes to prevent/minimize changes in mentation and maintain reality orientation.  Display effective problem-solving skills. confusion. unrealistic perceptions/ expectations. fear  Impaired judgment. emotional lability  Personal vulnerability. Can assist patient to develop and implement a vocational plan incorporating specific interests and/or abilities.  Verbalize awareness of own capabilities/strengths. 5. changes in thinking/behavior. as possible.

Repetition puts information in long-term memory. dealing with what happening. Note statements reflecting powerlessness. establish trust. and provide an opportunity to identify problems and begin the problem-solving process. or adult protective services may be required until (if ever) patient is able to manage ow affairs. being responsible for own care. Identify options available to individuals involved. handle finances. Provides a clue as to how patient may deal with what is currently happening. to display difficulties with concentration. verification is importan to ensure accuracy of communication. eye contact. May provide significant information about what patient is feeling. May diminish patient’s fear. inability to cope.Nursing Interventions Rationale Assess current functional capacity and limitations. and use of touch. Determine patient’s understanding of current situation and previous methods of dealing with life’s problems. Conservatorship. Encourage patient to tape-record important information and listen to the recording periodically. organizers. Compare with verbal content and verify meaning with patient as appropriate. cognitive dissonance. and helps identify individual resources and need for assistance. problem-solve. note presence of distorted thinking processes. guardianship. Provide clues for orientation: calendars. gestures. labile emotions. problem solving. Note how these affect the individual’s coping abilities. Impaired judgment. frustrating struggles associated with adaptation to altered environment or lifestyle. reality-oriented relationship. Observe nonverbal communication: posture. clocks. where it is more easily retrieved and can support . Organic or psychological effects may cause patien to be easily distracted. inadequate suppor systems may interfere with ability to meet own needs and needs of others. movements. Encourage verbalization of feelings and/or fears. accepting what patient says in a nonjudgmental manner. confusion. Discuss ability to make decisions. Maintain an honest. Discrepanc between feelings and what is being said can interfere with ability to cope. These serve as tangible reminders to aid recognition and permeate memory gaps and enab patient to cope with situation. care for children or dependent adults. however. Reduces confusion and minimizes painful. notecards.

Improving cognitive abilities can enhance basic thinking skills when attention span is short. 6. anxiety. imipramine (Tofranil). ability process information is impaired. psychiatric clinical nurse specialist and/or psychiatrist. May need additional help to resolve issues of selfesteem and regain effective coping skills. temporary family disorganization and role changes  Highly ambivalent family relationship  Prolonged disease/disability progression that exhausts the supportive capacity of SO  Patient providing little support in turn for SO  SO with chronically unexpressed feelings of guilt. bupropion (Wellbutrin).  SO preoccupied with own personal reactions  Intolerance. abandonment . patient is unable learn new tasks. Medications to improve mood and restful sleep ma be useful in combating depression and relieving degree of fatigue interfering with function. Refer to cognitive retraining program. Administer medications as appropriate: amitriptyline (Elavil). hostility. Refer to counseling. as indicated. Ineffective Family Coping May be related to  Situational crisis. and problem solving skills are impaired. despair Possibly evidenced by  Patient expresses/confirms concern or complaint about SO response to patient’s illness  SO withdraws or has limited personal communication with patient or displays protective behavior disproportionate to patient’s abilities or need for autonomy. or insight. judgment.Nursing Interventions Rationale decision-making and problem-solving process.

Fami members may view patient’s inability to perform activities as manipulative behavior rather than an actual physiological deficit. severity of illness. . Identify other responsibilities and factors impacting participation. Chronic illness. Note: A particular area of misconception the fatigue experienced by patients with MS. Individuals may not have desire or time to assume responsibility for care. Neglectful care of patient  Distortion of reality regarding patient’s illness Desired Outcomes  Identify/verbalize resources within themselves to deal with the situation.  Interact appropriately with patient/healthcare providers providing support and assistance as indicated. accompanied by changes in role performance and responsibility. Inadequate information and misconception regarding disease process and/or unrealistic expectations affect ability to cope with current situation. Additionally. Individual members’ preoccupation with own need and concerns can interfere with providing needed care and support for stresses of long-term illness.  Express more realistic understanding and expectations of patient.  Verbalize knowledge and understanding of disability/disease and community resources. they may be able to share tasks. Determine SO’s understanding of disease process and expectations for the future. If several family members a available. caregiver(s) may incur decrease or lo of income or risk losing own health insurance if the alter their work hours. Discuss with SO/family members their willingness to be involved in care. Assess other factors that are affecting abilities of family members to provide needed support. often exhausts supportive capacity and coping abilities of SO or family. Determine patient’s role in family and how illness has changed the family organization. Nursing Interventions Rationale Note length.

Provides information. including frustration. Helps SO understand and accept and deal with behaviors that may be triggered by emotional or physical effects of MS. Individual members may be afraid to express “negative” feelings. respite programs. and hopelessness. May need more in-depth assistance from professional sources. hostility. Free expression promotes awareness and can help with resolution of feelings and problems (especially when done in a caring manner). believing it will discourage patient. nocturia. frequency  Retention with overflow  Recurrent UTIs Desired Outcomes  Verbalize understanding of condition. home care agencies. an sources of assistance when needed.  Demonstrate behaviors/techniques to prevent/minimize infection. opportunities to share with others who are experiencing similar difficulties.Nursing Interventions Rationale Discuss underlying reasons for patient’s behaviors. . anger. Family may or may not have handled conflict well before illness. Impaired Urinary Elimination May be related to  Neuromuscular impairment (spinal cord lesions/neurogenic bladder) Possibly evidenced by  Incontinence. support groups. Encourage free expression of feelings. psychiatric clinical nurse specialist and psychiatrist as appropriate. Identify community resources and local MS organization. financial adviser. Refer to social worker. and stress of long-term debilitating condition can create additional problems (includin unresolved anger). 7. Encourage patient and SO to develop and strengthen problem-solving skills to deal with situation.

sufficient fluids are necessary t ensure adequate excretion of drug. Sufficient hydration promotes urinary output and aids in preventing infection. or unexplained increase in MS symptoms. Encourage adequate fluid intake. Helps restore adequate bladder functioning. urgency. Fullness over bladder following void is indicative o inadequate emptying or retention and requires intervention. and street. Recommend good hand washing and proper perineal care. may cause bladder irritation leading to bladder dysfunction. Note: Aspartame. Note: When patient is taking sulfa drugs. Decreases risk of developing UTI. Reduces skin irritation and risk of ascending infection. including prescribed. foul odor.g. Review drug regimen. Institute bladder training program or timed voidings as appropriate. incontinence. Empty bladder completely and regularly (voluntarily or by catheter as appropriate). Provides information about degree of interference with elimination or may indicate bladder infection. burning. Encourage patient to observe for sediments or blood in urine. avoiding caffeine and use of aspartame. Palpate bladder after voiding. nocturia. Nutrasweet). overthe-counter (OTC). A number of medications such as some antispasmodics. antidepressants. lesse occurrence of incontinence and bladder infection. Nursing Interventions Rationale Note reports of urinary frequency.. and limiting intake during late evening and at bedtime. Promote continued mobility. Refer to urinary continence specialist as indicated. reducing risk o cumulative effects. Recommend use of cranberry juice/ vitamin C. Helpful for developing individual plan of care to . or recreational drugs suc as cannabis may interfere with bladder emptying. Indicative of infection requiring further evaluation o treatment. a sugar substitute (e.  Be free of urine leakage. and size or force of urinary stream. fever. and narcotic analgesics. OTC medications with anticholinergic alpha agonist properties.

Obtain periodic urinalysis and urine culture and sensitivity as indicated.Nursing Interventions Rationale meet patient’s specific needs using the latest techniques. continence products. Prompt treatmen of infection is necessary to prevent serious complications of sepsis/shock 8. (Macrodantin). depending on patient’s abilities and degree of urinary problem. hyoscyamine sulfate (Cytospaz-M). Septra). information misinterpretation  Unfamiliarity with information resources  Cognitive limitation. Helps patient maintain autonomy and encourages self-care. urgency. Monitors renal status. Knowledge Deficit May be related to  Lack of exposure.000 indicates presence of infection requiring treatment Administer anti-infective agents as necessary: Nitrofurantoin macrocrystals. ciprofloxacin (Cipro). nocturia. lack of recall Possibly evidenced by  Statement of misconception . Administer medications as indicated: Oxybutynin (Ditropan). Colony count over 100. flavoxate hydrochloride (Urispas). tolterodine (Detrol). Indwelling catheter may be required. incontinence. norfloxacin (Noroxin). Bacteriostatic agents that inhibit bacterial growth and destroy susceptible bacteria. cotrimoxazole (Bactrim. Reduce bladder spasticity and associated symptoms of frequency. propantheline (ProBanthine). Catheterize as indicated. May be necessary as a treatment and for evaluatio if patient is unable to empty bladder or retains urin Teach self-catheterization and instruct in use and care of indwelling catheter.

Patient will not process or retain information and w have difficulty learning during this time.  Assume responsibility for own learning and begin to look for information and to ask questions. Changes in cognitive. audiovisuals.g. development of preventable complications  Inappropriate or exaggerated behaviors (e. Request of information  Inaccurate follow-through of instruction. Enhances sense of independence and control and may strengthen commitment to therapeutic regime Review disease process or prognosis. books. . overexertion. emotional stress.  Verbalize understanding of condition/disease process and treatment. auditory function impact choice of teaching modalities: verbal instruction. effects of climate.  Initiate necessary lifestyle changes.  Participate in prescribed treatment regimen. Provide information in varied formats depending on patient’s cognitive or perceptual abilities and considering patient’s locus of control. Note signs of emotional lability or whether patient is in dissociative state (loss of affect. Encourage active participation of patient or SO in learning process. agitated. including use of self-paced instruction as appropriate. apathetic) Desired Outcomes  Participate in learning process. Determines amount or level of information to provi at any given moment. Whether locus of control is internal or external affects patient’s attitude toward helpfulness of learning.. Nursing Interventions Rationale Evaluate desire and readiness of patient and SO and/or caregiver to learn. hysterical. fatigue. computer programs. hostile. inappropriate emotional responses). visual. pamphlets. Clarifies patient or SO understanding of individual situation.

Review of risk factors can help patient take measures to maintain physical state at optimal level/prevent complications. Prompt intervention may help limit severity of exacerbation or complications. Stress necessity of weight control. Review possible problems that may arise. or possibly Constipation is common. especially UTI. Identify actions that can be taken to avoid injury.g. eating utensils. Identify bowel elimination concerns. vitamin D deficiency (possibly result increased of decreased exposure to sunligh which can exacerbate MS symptoms). e.g. intake of calcium and vitamin D. Excess weight can interfere with balance and mot abilities and make care more difficult. These effects of demyelination and associated complications may compromise patient safety and/or precipitate an exacerbation of symptoms. e. bulking agents.g. Recommend adequate hydration and intake of fiber.. Discuss increased risk of osteoporosis and review preventive measures. activity. cessation of smoking. focusing on current capabilities. Helps patient maintain current level of physical independence and may limit fatigue.g. removal of small area rugs. force fluids.. inspect skin regularly. reduced intake of caffeine. take care with transfers and wheelchair/ walker mobility. walking aids.. and decreased likelihood of engaging in preventive measures increase bone mass loss and the risk o fractures. Discuss importance of daily routine of rest. and fall prevention measures such as wearing low-heeled shoes with nonskid soles. and get adequate nutrition.. use of handrails/ grab bars in bathroom and along stairwells. and bowel urgency and/o accidents may occur as a result of dietary deficiencies or impaction. hormone replacement therapy (HRT) or alternatives (e.Nursing Interventions Rationale Identify signs and symptoms requiring further evaluation. e. and eating. bisphosphonates—Fosamax). regular exercise. . Decreased mobility. Instruct in use of appropriate devices to assist with ADLs. susceptibility to skin breakdown and infections. suppositories. avoid hot baths. use of stool softeners. such as decreased perception of heat and pain. Encourage avoidance of persons with upper respiratory infection. exercise.

effects of pregnancy on affected woman. and leve of independence. relevant support groups. genitourinary (GU) referral for males regarding available medication and sexual aids. Risk for Caregiver Role Strain . counsel regarding use of artificial lubrication (females). cuddling) may enhance personal relationship and feelings of self-worth. mailings) informs patient of programs and services available. May need assessment of capabilities and job retraining as indicated by individual limitations and disease progression. Encourage patient to set goals for the future while focusing on the “here and now. sharing of information and enhance problem-solving ability. Recommend contacting local and national MS organizations. bowel training program. Discuss concerns regarding sexual relationships.” what can be done today. Support groups can provide role modeling. 9. Information abo different positions and techniques and/or other options for sexual fulfillment (e. Reduces likelihood of drug interactions and/or adverse effects. Identify financial concerns.g.g. Recommend avoidance of OTC drugs.. Pregnancy may be an issue for the young patient relative to issues of genetic predisposition and/or ability to manage pregnancy or parent offspring. Refer for vocational rehabilitation as appropriate. Ongoing contact (e. Having a plan for the future helps retain hope and provides opportunity for patient to see that althoug today is to be lived.. one can plan for tomorrow eve in the worst of circumstances. Identify alternative ways to meet individual needs. contraception and reproduction. insurance benefits. Increased libido is not uncommon and may require adjustments within the existing relationship or in th absence of an acceptable partner. and enhances cooperation with treatment regimen. requiring additional family and social support. Review specifics of individual medications. fondling. and can update patient’s knowledge base. Loss or change of employment (for patient and/or SO) impacts income.Nursing Interventions Rationale mild laxatives.

Organizations can provide information regarding adequacy of supports and identify needs. Determine caregiver’s level of commitment. responsibility. Discuss caregiver’s view of and about situation.  complexity/amount of caregiving task  Caregiver is female. Progressive debilitation taxes caregiver and may alter ability to meet patient or own needs. to further determine caregiver’s abilities. lack of respite and recreation Desired Outcomes  Identify individual risk factors and appropriate interventions. such as Burden Interview.  Report satisfaction with plan and support available. spouse  Care receiver exhibits deviant. Nursing Interventions Rationale Note physical/mental condition. Facilitate family conference to share information and develop plan for involvement in care activities as appropriate. promoting understanding. . Determine available supports and resources currently used. Allows ventilation and clarification of concerns. involvement in and anticipated length of care. Use assessment tool.  Demonstrate/initiate behaviors or lifestyle changes to prevent development of impaired function. as well as disabilities requiring accommodation. Determines individual needs for planning care. duration of caregiving required.Risk factors may include  Severity of illness of the care receiver. when appropriate. When others are involved in care.  Use available resources appropriately. the risk of one person’s becoming overloaded is lessened. Identifies strengths and how much responsibility patient may be expected to assume. therapeutic regimen of care receiver. bizarre behavior  Family/caregiver isolation.

personal needs. legal assistance. reduced temperature/tactile sensation. Other Possible Nursing Care Plans  Trauma. These areas of concern can add to burden of caregiving if not adequately resolved. reduced muscle and hand/eye coordination. severe pain. and social activities. Provide information and/or demonstrate techniques for dealing with acting-out or violent or disoriented behavior. poor vision. Helps caregiver maintain sense of control and competency. Planning for this eventually is important for the tim when burden of care becomes too great. risk for/[actual]—paralysis/immobilization. Identify alternate care sources (such as sitter or day care facility). social support deficits. Identify adaptive equipment needs and resources for the home and vehicles. hobbies.  Disuse Syndrome.  Home Maintenance. unfamiliarity with neighborhood resources. Enhances independence and safety of both caregiver and patient. impaired—insufficient finances. insufficient finances to purchase necessary equipment.Nursing Interventions Rationale Identify additional resources to include financial. balancing difficulties. home care agency. cognitive or emotional difficulties. Taking time for self can lessen risk of “burnout”/being overwhelmed by situation. Assist caregiver to plan for changes that may be necessary for the care receiver (eventual placement in extended care facility). senior care services. inadequate support systems. Enhances safety for care receiver an caregiver. risk for—weakness. Medical case manager or social services consulta may be needed to develop ongoing plan to meet changing needs of patient and SO/family. Refer to supportive services as need indicates.  Therapeutic Regimen: ineffective management—economic difficulties. SO may need additional help from several sources to maintain patient at home even on a part-time basis. family conflict. . Stress importance of self-nurturing: pursuing selfdevelopment interests. As patient’s condition worsens.