CLOSE

EXAMS
MNEMONICS
CARE PLANS
NOTES
CAREER
NEWS
LIFESTYLE
VIDEOS
Nurseslabs

Home Nursing Care Plans 9 Multiple Sclerosis Nursing Care Plans

NURSING CARE PLANS
9 Multiple Sclerosis Nursing Care Plans

By Matt Vera, RN - Mar 5, 2014 0

1k898Facebook1174

Multiple sclerosis (MS) is the most common of the demyelinating disorders and the predominant
CNS disease among young adults. MS is a progressive disease caused by demyelination of the
white matter of the brain and spinal cord. In this disease, sporadic patches of demyelination
throughout the central nervous system induce widely disseminated and varied neurologic
dysfunction. MS is characterized by exacerbations and remissions, MS is a major cause of
chronic disability in young adults.

The prognosis varies. MS may progress rapidly , disabling some patients by early adulthood or
causing death within months of onset. However, 70% of patients lead active, productive lives
with prolonged remissions.

The exact cause of MS is unknown, but current theories suggest a slow-acting or latent viral
infection and an autoimmune response. Other theories suggests that environmental and genetic
factors may also be linked to MS. Stress, fatigue, overworking, pregnancy or acute respiratory
tract infections have been known to precede the onset of this illness. MS usually begins
between ages 20 and 40. It affects more women than men.
Nursing Care Plans

The goal of treatment is to shorten exacerbations and relieve neurologic deficits so that the
patient can resume a normal lifestyle. With that, here are 9 multiple sclerosis nursing care plans
(NCP).

1. Fatigue

May be related to

Decreased energy production, 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; decreased performance
Impaired ability to concentrate; disinterest in surroundings
Increase in physical complaints
Desired Outcomes

Identify risk factors and individual actions affecting fatigue.

Identify alternatives to help maintain desired activity level.
Participate in recommended treatment program.
Report improved sense of energy.
Nursing Interventions Rationale
Note and accept presence of fatigue.Fatigue is 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.
Identify and review factors affecting ability to be active: temperature extremes, inadequate food
intake, insomnia, use of medications, time of day. Provides opportunity to problem-solve to
maintain or improve mobility.
Accept when patient is unable to do activities. 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.
Determine need for walking aids. Provide braces, walkers, or wheelchairs. Review safety
considerations. 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.
Schedule ADLs in the morning if appropriate. Investigate use of cooling vest. Fatigue
commonly worsens in late afternoon (when body temperature rises). Some patients report
lessening of fatigue with stabilization of body temperature.
Plan care consistent rest periods between activities. Encourage afternoon nap. Reduces
fatigue, aggravation of muscle weakness.
Assist with physical therapy. Increase patient comfort with massages and relaxing baths.
Reduces fatigue and promotes sense of wellness.
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 discouragement. In
time, patient can become very adept at knowing limitations.
Investigate appropriateness of obtaining a service dog. Service dogs can increase patient’s
level of independence. They can also assist in energy conservation by carrying items in “saddle”
bags and retrieving or performing tasks.
Recommend participation in groups involved in fitness or exercise and/or the Multiple Sclerosis
Society. Can help patient to stay motivated to remain active within the limits of the
disability or condition. Group activities need to be selected carefully to meet patient’s needs and
prevent discouragement or anxiety.
Administer medications as indicated:
Amantadine (Symmetrel); pemoline (Cylert) 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 and feet.
Methylphenidate (Ritalin), modafinil (Provigil) CNS stimulants that may reduce fatigue but
may also cause side effects of nervousness, restlessness, and insomnia.
Sertraline (Zoloft), fluoxetine (Prozac) 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: amitriptyline (Elavil), nortriptyline (Pamelor) Useful in treating
emotional lability, neurogenic pain, and associated sleep disorders to enhance willingness to be
more active.
Anticonvulsants: carbamazepine (Tegretol), gabapentin (Neurontin), lamotrigine (Lamictal)
Used to treat neurogenic pain and sudden intermittent spasms related to spinal cord irritation.
Steroids: prednisone (Deltasone), dexamethasone (Decadron), methyl-prednisolone
(Solu-Medrol) May be used during acute exacerbations to reduce and prevent edema formation
at the sclerotic plaques. Note: Long-term therapy seems to have little effect on progression of
symptoms.
Vitamin B Supports nerve-cell replication, enhances metabolic functions, and may increase
sense of well-being and energy level.
Immuno-modulating agents: cyclo phosphamide (Cytoxan), azathioprine (Imuran), methotrexate
(Mexate), interferon [beta]-1B (Betaseron); interferon [beta]-1A (Avonex, Rebif), glatiramer
(Copaxone); mitoxantrone (Novantrone). May be used to treat acute relapses, reduce the
frequency of relapse, and promote remission. Interferon [beta]-1B (Betaseron) has been
approved for use by ambulatory patients with remitting relapsing MS and is the first drug found
to alter the course of the disease. Current research indicates early treatment with drugs that
reduce inflammation and lesion formation may limit permanent damage. Therapy of choice is “A,
B, C” drugs: Avonex, Betaseron, and Copaxone. Therapeutic benefits have been reported in
patients at all stages of disability with reduction in both steroid use and hospital days.
(Copaxone chemically resembles a component of myelin and may act as a decoy, 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.
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. Self-care Deficit

May be related to

Neuromuscular/perceptual impairment; intolerance to activity; decreased strength and

endurance; motor impairment, tremors
Pain, discomfort, fatigue
Memory loss
Depression
Possibly evidenced by

Frustration; inability to perform tasks of self-care, poor personal hygiene

Desired Outcomes

Identify individual areas of weakness/needs.

Demonstrate techniques/lifestyle changes to meet self-care needs.
Perform self-care activities within level of own ability.
Identify personal/community resources that provide assistance.
Nursing Interventions Rationale
Determine current activity level and physical condition. Assess degree of functional impairment
using 0–4 scale. Provides information to develop plan of care for rehabilitation. Note: Motor
symptoms are less likely to improve than sensory ones.
Encourage patient to perform self-care to the maximum of ability as defined by patient. Do not
rush patient. Promotes independence and sense of control; may decrease feelings of
helplessness.
Assist according to degree of disability; allow as much autonomy as possible. Participation
in own care can ease the frustration over loss of independence.
Encourage patient input in planning schedule. Patient’s quality of life is enhanced when
desires and likes are considered in daily activities.
Note presence of fatigue. Fatigue experienced by patients with MS can be very debilitating
and greatly impact ability to participate in ADLs. The subjective nature of reports of fatigue can
be misinterpreted by healthcare providers and family, leading to conflict and the belief that the
patient is “manipulative” when, in fact, this may not be the case.
Encourage scheduling activities early in the day or during the time when energy level is best.
Patients with MS expend a great deal of energy to complete ADLs, increasing the risk of fatigue,
which often progresses through the day.
Allot sufficient time to perform tasks, and display patience when movements are slow.
Decreased motor skills and spasticity may interfere with ability to manage even simple activities.
Anticipate hygienic needs and calmly assist as necessary with care of nails, skin, and hair;
mouth care; shaving. 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.
Provide assistive devices and aids as indicated: shower chair, elevated toilet seat with arm
supports. Reduces fatigue, enhancing participation in self-care.
Reposition frequently when patient is immobile (bed or chair bound). Provide skin care to
pressure points, such as sacrum, ankles, and elbows. Position properly and encourage to sleep
prone as tolerated. Reduces pressure on susceptible areas, prevents skin breakdown.
Minimizes flexor spasms at knees and hips.
Provide massage and active or passive ROM exercises on a regular schedule. Encourage use
of splints or footboards as indicated. Prevents problems associated with muscle dysfunction and
disuse. Helps maintain muscle tone and strength and joint mobility, and decreases risk of loss of
calcium from bones.
Encourage stretching and toning exercises and use of medications, cold packs, and splints and
maintenance of proper body alignment, when indicated. Helps decrease spasticity and its
effects.
Problem-solve ways to meet nutritional and fluid needs. Provides for adequate intake and
enhances patient’s feelings of independence or self-esteem.
Consult with physical and/or occupational therapist. Useful in identifying devices and/or
equipment to relieve spastic muscles, improve motor functioning, prevent and reduce muscular
atrophy and contractures, promoting independence and increasing sense of self-worth.
Administer medications as indicated:
Tizanidine (Zanaflex), baclofen (Lioresal), carbamazepine (Tegretol); Newer drugs used for
reducing spasticity, promoting muscle relaxation, and inhibiting reflexes at the spinal nerve root
level. Enhance mobility and maintenance of activity. Tizanidine (Zanaflex) may have an additive
effect with baclofen (Lioresal), but use with caution because both drugs have similar side
effects. Short duration of action requires careful individualizing of dosage to maximize
therapeutic effect.
Diazepam (Valium), clonazepam (Klonopin), cyclobenzaprine (Flexeril), gabapentin (Neurontin,
dantrolene (Dantrium); A variety of medications are used to reduce spasticity. The
mechanisms are not well understood, and responses vary in each person. Therefore, it may
take a period of medication trials to discover what provides the most effective relief of muscle
spasticity and associated pain. Note: Adverse effects may be increased muscle weakness, loss
of muscle tone, and liver toxicity.
Meclizine (Antivert), scopolamine patches (Transderm-Scop). Reduces dizziness, allowing
patient to be more mobile.
3. Low Self-Esteem

May be related to
Change in structure/function
Disruption in how patient perceives own body
Role reversal; dependence
Possibly evidenced by

Confusion about sense of self, purpose, direction in life

Denial, withdrawal, 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.

View self as a capable person.
Participate in and assume responsibility for meeting own needs.
Recognize and incorporate changes in self-concept/role without negating self-esteem.
Develop realistic plans for adapting to role changes.
Nursing Interventions Rationale
Establish and maintain a therapeutic nurse-patient relationship, discussing fears and concerns.
Conveys an attitude of caring and develops a sense of trust between patient and caregiver in
which patient is free to express fears of rejection, loss of previous functioning and/or
appearance, feelings of helplessness, powerlessness about changes that may occur. Promotes
a sense of well-being for patient.
Note withdrawn behaviors and use of denial or over concern with body and disease process.
Initially may be a normal protective response, but if prolonged, may prevent dealing
appropriately with reality and may lead to ineffective coping.
Support use of defense mechanisms, allowing patient to deal with information in own time and
way. Confronting patient with reality of situation may result in increased anxiety and lessened
ability to cope with changed self-concept/role.
Acknowledge reality of grieving process related to actual or perceived changes. Help patient
deal realistically with feelings of anger and sadness. Nature of the disease leads to
ongoing losses and changes in all aspects of life, blocking resolution of grieving process.
Review information about course of disease, possibility of remissions, prognosis. When patient
learns about disease and becomes aware that own behavior (including feeling hopeful/
maintaining a positive attitude) can significantly improve general well-being and daily
functioning, patient may feel more in control, enhancing sense of self-esteem. Note: Some
patients may never have a remission.
Provide accurate verbal and written information about what is happening and discuss with
patient/SO. Helps patient stay in the “here and now,” reduces fear of the unknown; provides
reference source for future use.
Explain that labile emotions are not unusual. Problem-solve ways to deal with these feelings.
Relieves anxiety and assists with efforts to manage unexpected emotional displays.
Note presence of depression and impaired thought processes, expressions of suicidal ideation
(evaluate on a scale of 1–10). Adapting to a long-term, progressively debilitating
incurable disease is a difficult emotional adjustment. In addition, cognitive impairment may
affect adaptation to life changes. A depressed individual may believe that suicide is the best
way to deal with what is happening.
Assess interaction between patient and SO. Note changes in relationship. SO may
unconsciously or consciously reinforce negative attitudes and beliefs of patient, or issues of
secondary gain may interfere with progress and ability to manage situation.
Provide open environment for patient and SO to discuss concerns about sexuality, including
management of fatigue, spasticity, arousal, and changes in sensation. Physical and
psychological changes often create stressors within the relationship, affecting usual roles and
expectations, further impairing self-concept.
Discuss use of medications and adjuncts to improve sexual function. Patient and partner
may want to explore trial of medications (papaverine [Pavabid], dinoprostone [Prostin E2]) or
other avenues of improving sexual relationship.
Consult with occupational therapist/ rehabilitation team. Identifying assistive devices and/or
equipment enhances level of overall function and participation in activities, enhancing sense of
well-being and viewing self as a capable individual.
4. Powerlessness/Hopelessness

Nursing Diagnosis

Powerlessness
Hopelessness
May be related to

Illness-related regimen, 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, decreased verbalization/affect
Verbal cues
Lack of involvement in care/passively allowing care
Isolating behaviors/social withdrawal
Desired Outcomes

Identify and verbalize feelings.

Use coping mechanisms to counteract feelings of hopelessness.
Identify areas over which individual has control.
Participate/monitor and control own self-care and ADLs within limits of the individual situation.
Nursing Interventions Rationale
Note behaviors indicative of powerlessness or hopelessness. Patient may say statements of
despair. The degree to which patient believes own situation is hopeless, that he or she is
powerless to change what is happening, affects how patient handles life situation.
Acknowledge reality of situation, at the same time expressing hope for 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 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, patient has a sense of control over own circumstances.
Determine degree of mastery patient has exhibited in life to the present. Note locus of control.
Patient who has assumed responsibility in life previously tends to do the same during difficult
times of exacerbation of illness. However, if locus of control has been focused outward, patient
may blame others and not take control over own circumstances.
Assist patient to identify factors that are under 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 individual can control.
Encourage patient to assume control over as much of own care as possible. Even when
unable to do much physical care, 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 patient feels powerless and not listened to.
Incorporate patient’s daily routine into home care schedule or hospital stay, as possible.
Maintains sense of control and self-determination and independence.
Refer to vocational rehabilitation as indicated. Can assist patient to develop and
implement a vocational plan incorporating specific interests and/or abilities.
Identify community resources. Participation in structured activities can reduce sense of
isolation and may enhance feeling of self-worth.
5. Risk for Ineffective Coping

Risk factors may include

Physiological changes (cerebral and spinal lesions)

Psychological conflicts; anxiety; fear
Impaired judgment, short-term memory loss; confusion; unrealistic perceptions/ expectations,
emotional lability
Personal vulnerability; inadequate support systems
Multiple life changes
Inadequate coping methods
Possibly evidenced by

Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has
not occurred and nursing interventions are directed at prevention.
Desired Outcomes

Recognize relationship between disease process (cerebral lesions) and emotional responses,
changes in thinking/behavior.
Verbalize awareness of own capabilities/strengths.
Display effective problem-solving skills.
Demonstrate behaviors/lifestyle changes to prevent/minimize changes in mentation and
maintain reality orientation.
Nursing Interventions Rationale
Assess current functional capacity and limitations; note presence of distorted thinking
processes, labile emotions, cognitive dissonance. Note how these affect the individual’s coping
abilities. Organic or psychological effects may cause patient to be easily distracted, to
display difficulties with concentration, problem solving, dealing with what is happening, being
responsible for own care.
Determine patient’s understanding of current situation and previous methods of dealing with
life’s problems. Provides a clue as to how patient may deal with what is currently
happening, and helps identify individual resources and need for assistance.
Discuss ability to make decisions, care for children or dependent adults, handle finances.
Identify options available to individuals involved. Impaired judgment, confusion, inadequate
support systems may interfere with ability to meet own needs and needs of others.
Conservatorship, guardianship, or adult protective services may be required until (if ever)
patient is able to manage own affairs.
Maintain an honest, reality-oriented relationship. Reduces confusion and minimizes painful,
frustrating struggles associated with adaptation to altered environment or lifestyle.
Encourage verbalization of feelings and/or fears, accepting what patient says in a
nonjudgmental manner. Note statements reflecting powerlessness, inability to cope. May
diminish patient’s fear, establish trust, and provide an opportunity to identify problems and begin
the problem-solving process.
Observe nonverbal communication: posture, eye contact, movements, gestures, and use of
touch. Compare with verbal content and verify meaning with patient as appropriate. May
provide significant information about what patient is feeling; however, verification is important to
ensure accuracy of communication. Discrepancy between feelings and what is being said can
interfere with ability to cope, problem-solve.
Provide clues for orientation: calendars, clocks, notecards, organizers. These serve as
tangible reminders to aid recognition and permeate memory gaps and enable patient to cope
with situation.
Encourage patient to tape-record important information and listen to the recording periodically.
Repetition puts information in long-term memory, where it is more easily retrieved and can
support decision-making and problem-solving process.
Refer to cognitive retraining program. Improving cognitive abilities can enhance basic
thinking skills when attention span is short; ability to process information is impaired; patient is
unable to learn new tasks; or insight, judgment, and problem-solving skills are impaired.
Refer to counseling, psychiatric clinical nurse specialist and/or psychiatrist, as indicated. May
need additional help to resolve issues of self-esteem and regain effective coping skills.
Administer medications as appropriate: amitriptyline (Elavil); bupropion (Wellbutrin); imipramine
(Tofranil); Medications to improve mood and restful sleep may be useful in combating
depression and relieving degree of fatigue interfering with function.
6. Ineffective Family Coping

May be related to

Situational crisis; 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, anxiety, hostility, 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.
SO preoccupied with own personal reactions
Intolerance, abandonment
Neglectful care of patient
Distortion of reality regarding patient’s illness
Desired Outcomes

Identify/verbalize resources within themselves to deal with the situation.

Express more realistic understanding and expectations of patient.
Interact appropriately with patient/healthcare providers providing support and assistance as
indicated.
Verbalize knowledge and understanding of disability/disease and community resources.
Nursing Interventions Rationale
Note length, severity of illness. Determine patient’s role in family and how illness has changed
the family organization. Chronic illness, accompanied by changes in role performance and
responsibility, often exhausts supportive capacity and coping abilities of SO or family.
Determine SO’s understanding of disease process and expectations for the future.
Inadequate information and misconception regarding disease process and/or unrealistic
expectations affect ability to cope with current situation. Note: A particular area of misconception
is the fatigue experienced by patients with MS. Family members may view patient’s inability to
perform activities as manipulative behavior rather than an actual physiological deficit.
Discuss with SO/family members their willingness to be involved in care. Identify other
responsibilities and factors impacting participation. Individuals may not have desire or time to
assume responsibility for care. If several family members are available, they may be able to
share tasks.
Assess other factors that are affecting abilities of family members to provide needed support.
Individual members’ preoccupation with own needs and concerns can interfere with providing
needed care and support for stresses of long-term illness. Additionally, caregiver(s) may incur
decrease or loss of income or risk losing own health insurance if they alter their work hours.
Discuss underlying reasons for patient’s behaviors. Helps SO understand and accept and deal
with behaviors that may be triggered by emotional or physical effects of MS.
Encourage patient and SO to develop and strengthen problem-solving skills to deal with
situation. Family may or may not have handled conflict well before illness, and stress of
long-term debilitating condition can create additional problems (including unresolved anger).
Encourage free expression of feelings, including frustration, anger, hostility, and hopelessness.
Individual members may be afraid to express “negative” feelings, believing it will discourage
patient. Free expression promotes awareness and can help with resolution of feelings and
problems (especially when done in a caring manner).
Identify community resources and local MS organization, support groups, home care agencies,
respite programs. Provides information, opportunities to share with others who are
experiencing similar difficulties, and sources of assistance when needed.
Refer to social worker, financial adviser, psychiatric clinical nurse specialist and psychiatrist as
appropriate. May need more in-depth assistance from professional sources.
7. Impaired Urinary Elimination

May be related to

Neuromuscular impairment (spinal cord lesions/neurogenic bladder)

Possibly evidenced by

Incontinence; nocturia; frequency

Retention with overflow
Recurrent UTIs
Desired Outcomes

Verbalize understanding of condition.

Demonstrate behaviors/techniques to prevent/minimize infection.
Empty bladder completely and regularly (voluntarily or by catheter as appropriate).
Be free of urine leakage.
Nursing Interventions Rationale
Note reports of urinary frequency, urgency, burning, incontinence, nocturia, and size or force of
urinary stream. Palpate bladder after voiding. Provides information about degree of
interference with elimination or may indicate bladder infection. Fullness over bladder following
void is indicative of inadequate emptying or retention and requires intervention.
Review drug regimen, including prescribed, over-the-counter (OTC), and street. A number of
medications such as some antispasmodics, antidepressants, and narcotic analgesics; OTC
medications with anticholinergic or alpha agonist properties; or recreational drugs such as
cannabis may interfere with bladder emptying.
Institute bladder training program or timed voidings as appropriate.Helps restore adequate
bladder functioning; lessens occurrence of incontinence and bladder infection.
Encourage adequate fluid intake, avoiding caffeine and use of aspartame, and limiting intake
during late evening and at bedtime. Recommend use of cranberry juice/ vitamin C.
Sufficient hydration promotes urinary output and aids in preventing infection. Note: When patient
is taking sulfa drugs, sufficient fluids are necessary to ensure adequate excretion of drug,
reducing risk of cumulative effects. Note: Aspartame, a sugar substitute (e.g., Nutrasweet), may
cause bladder irritation leading to bladder dysfunction.
Promote continued mobility. Decreases risk of developing UTI.
Recommend good hand washing and proper perineal care. Reduces skin irritation and risk of
ascending infection.
Encourage patient to observe for sediments or blood in urine, foul odor, fever, or unexplained
increase in MS symptoms. Indicative of infection requiring further evaluation or treatment.
Refer to urinary continence specialist as indicated. Helpful for developing individual plan of care
to meet patient’s specific needs using the latest techniques, continence products.
Administer medications as indicated:
Oxybutynin (Ditropan), propantheline (Pro-Banthine), hyoscyamine sulfate (Cytospaz-M),
flavoxate hydrochloride (Urispas), tolterodine (Detrol). Reduce bladder spasticity and
associated symptoms of frequency, urgency, incontinence, nocturia.
Catheterize as indicated. May be necessary as a treatment and for evaluation if patient is
unable to empty bladder or retains urine.
Teach self-catheterization and instruct in use and care of indwelling catheter. Helps patient
maintain autonomy and encourages self-care. Indwelling catheter may be required, depending
on patient’s abilities and degree of urinary problem.
Obtain periodic urinalysis and urine culture and sensitivity as indicated. Monitors renal status.
Colony count over 100,000 indicates presence of infection requiring treatment.
Administer anti-infective agents as necessary:
Nitrofurantoin macrocrystals. (Macrodantin); co-trimoxazole (Bactrim, Septra); ciprofloxacin
(Cipro); norfloxacin (Noroxin). Bacteriostatic agents that inhibit bacterial growth and
destroy susceptible bacteria. Prompt treatment of infection is necessary to prevent serious
complications of sepsis/shock
8. Knowledge Deficit

May be related to

Lack of exposure; information misinterpretation

Unfamiliarity with information resources
Cognitive limitation, lack of recall
Possibly evidenced by
Statement of misconception
Request of information
Inaccurate follow-through of instruction; development of preventable complications
Inappropriate or exaggerated behaviors (e.g., hysterical, hostile, agitated, apathetic)
Desired Outcomes

Participate in learning process.

Assume responsibility for own learning and begin to look for information and to ask questions.
Verbalize understanding of condition/disease process and treatment.
Initiate necessary lifestyle changes.
Participate in prescribed treatment regimen.
Nursing Interventions Rationale
Evaluate desire and readiness of patient and SO and/or caregiver to learn. Determines
amount or level of information to provide at any given moment.
Note signs of emotional lability or whether patient is in dissociative state (loss of affect,
inappropriate emotional responses). Patient will not process or retain information and will have
difficulty learning during this time.
Provide information in varied formats depending on patient’s cognitive or perceptual abilities and
considering patient’s locus of control. Changes in cognitive, visual, auditory function
impact choice of teaching modalities: verbal instruction, books, pamphlets, audiovisuals,
computer programs. Whether locus of control is internal or external affects patient’s attitude
toward helpfulness of learning.
Encourage active participation of patient or SO in learning process, including use of self-paced
instruction as appropriate. Enhances sense of independence and control and may strengthen
commitment to therapeutic regimen.
Review disease process or prognosis, effects of climate, emotional stress, overexertion, fatigue.
Clarifies patient or SO understanding of individual situation.
Identify signs and symptoms requiring further evaluation. Prompt intervention may help limit
severity of exacerbation or complications.
Discuss importance of daily routine of rest, exercise, activity, and eating, focusing on current
capabilities. Instruct in use of appropriate devices to assist with ADLs, e.g., eating utensils,
walking aids. Helps patient maintain current level of physical independence and may limit
fatigue.
Stress necessity of weight control. Excess weight can interfere with balance and motor
abilities and make care more difficult.
Review possible problems that may arise, such as decreased perception of heat and pain,
susceptibility to skin breakdown and infections, especially UTI. These effects of
demyelination and associated complications may compromise patient safety and/or precipitate
an exacerbation of symptoms.
Identify actions that can be taken to avoid injury, e.g., avoid hot baths, inspect skin regularly,
take care with transfers and wheelchair/ walker mobility, force fluids, and get adequate nutrition.
Encourage avoidance of persons with upper respiratory infection. Review of risk factors can
help patient take measures to maintain physical state at optimal level/prevent complications.
Discuss increased risk of osteoporosis and review preventive measures, e.g., regular exercise,
intake of calcium and vitamin D, reduced intake of caffeine, cessation of smoking, hormone
replacement therapy (HRT) or alternatives (e.g., bisphosphonates—Fosamax), and fall
prevention measures such as wearing low-heeled shoes with nonskid soles, use of handrails/
grab bars in bathroom and along stairwells, removal of small area rugs. Decreased mobility,
vitamin D deficiency (possibly a result increased of decreased exposure to sunlight, which can
exacerbate MS symptoms), and decreased likelihood of engaging in preventive measures
increase bone mass loss and the risk of fractures.
Identify bowel elimination concerns. Recommend adequate hydration and intake of fiber; use of
stool softeners, bulking agents, suppositories, or possibly mild laxatives; bowel training
program. Constipation is common, and bowel urgency and/or accidents may occur as a
result of dietary deficiencies or impaction.
Review specifics of individual medications. Recommend avoidance of OTC drugs.
Reduces likelihood of drug interactions and/or adverse effects, and enhances cooperation with
treatment regimen.
Discuss concerns regarding sexual relationships, contraception and reproduction, effects of
pregnancy on affected woman. Identify alternative ways to meet individual needs; counsel
regarding use of artificial lubrication (females), genitourinary (GU) referral for males regarding
available medication and sexual aids. Pregnancy may be an issue for the young patient
relative to issues of genetic predisposition and/or ability to manage pregnancy or parent
offspring. Increased libido is not uncommon and may require adjustments within the existing
relationship or in the absence of an acceptable partner. Information about different positions and
techniques and/or other options for sexual fulfillment (e.g., fondling, cuddling) may enhance
personal relationship and feelings of self-worth.
Encourage patient to set goals for the future while focusing on the “here and now,” what can be
done today. Having a plan for the future helps retain hope and provides opportunity for patient
to see that although today is to be lived, one can plan for tomorrow even in the worst of
circumstances.
Identify financial concerns. Loss or change of employment (for patient and/or SO) impacts
income, insurance benefits, and level of independence, requiring additional family and social
support.
Refer for vocational rehabilitation as appropriate. May need assessment of capabilities and
job retraining as indicated by individual limitations and disease progression.
Recommend contacting local and national MS organizations, relevant support groups.
Ongoing contact (e.g., mailings) informs patient of programs and services available, and can
update patient’s knowledge base. Support groups can provide role modeling, sharing of
information and enhance problem-solving ability.
9. Risk for Caregiver Role Strain

Risk factors may include

Severity of illness of the care receiver, duration of caregiving required,

complexity/amount of caregiving task
Caregiver is female, spouse
Care receiver exhibits deviant, bizarre behavior
Family/caregiver isolation; lack of respite and recreation
Desired Outcomes

Identify individual risk factors and appropriate interventions.

Demonstrate/initiate behaviors or lifestyle changes to prevent development of impaired function.
Use available resources appropriately.
Report satisfaction with plan and support available.
Nursing Interventions Rationale
Note physical/mental condition, therapeutic regimen of care receiver. Determines individual
needs for planning care. Identifies strengths and how much responsibility patient may be
expected to assume, as well as disabilities requiring accommodation.
Determine caregiver’s level of commitment, responsibility, involvement in and anticipated length
of care. Use assessment tool, such as Burden Interview, to further determine caregiver’s
abilities, when appropriate. Progressive debilitation taxes caregiver and may alter ability to
meet patient or own needs.
Discuss caregiver’s view of and about situation. Allows ventilation and clarification of
concerns, promoting understanding.
Determine available supports and resources currently used. Organizations can provide
information regarding adequacy of supports and identify needs.
Facilitate family conference to share information and develop plan for involvement in care
activities as appropriate. When others are involved in care, the risk of one person’s
becoming overloaded is lessened.
Identify additional resources to include financial, legal assistance. These areas of concern can
add to burden of caregiving if not adequately resolved.
Identify adaptive equipment needs and resources for the home and vehicles. Enhances
independence and safety of both caregiver and patient.
Provide information and/or demonstrate techniques for dealing with acting-out or violent or
disoriented behavior. Helps caregiver maintain sense of control and competency. Enhances
safety for care receiver and caregiver.
Stress importance of self-nurturing: pursuing self-development interests, personal needs,
hobbies, and social activities. Taking time for self can lessen risk of “burnout”/being
overwhelmed by situation.
Identify alternate care sources (such as sitter or day care facility), senior care services, home
care agency. As patient’s condition worsens, SO may need additional help from several
sources to maintain patient at home even on a part-time basis.
Assist caregiver to plan for changes that may be necessary for the care receiver (eventual
placement in extended care facility). Planning for this eventually is important for the time when
burden of care becomes too great.
Refer to supportive services as need indicates. Medical case manager or social services
consultant may be needed to develop ongoing plan to meet changing needs of patient and
SO/family.
Other Possible Nursing Care Plans

Trauma, risk for—weakness, poor vision, balancing difficulties, reduced temperature/tactile

sensation, reduced muscle and hand/eye coordination, cognitive or emotional difficulties,
insufficient finances to purchase necessary equipment.
Home Maintenance, impaired—insufficient finances, unfamiliarity with neighborhood resources,
inadequate support systems.
Disuse Syndrome, risk for/[actual]—paralysis/immobilization, severe pain.
Therapeutic Regimen: ineffective management—economic difficulties, family conflict, social
support deficits.
See Also

Nursing Care Plans

1k898Facebook1174

TAGSCENTRAL NERVOUS SYSTEMDEGENERATIVE

DISEASESFATIGUEHOPELESSNESSIMPAIRED URINARY ELIMINATIONINEFFECTIVE
FAMILY COPINGKNOWLEDGE DEFICITLOW SELF-ESTEEMPOWERLESSNESSRISK FOR
CAREGIVER ROLE STRAINRISK FOR INEFFECTIVE COPINGSELF-CARE DEFICIT
Previous article
Cancer and Oncology Nursing NCLEX Practice Quiz 3 (25 Items)
Next article
5 Total Joint (Knee, Hip) Replacement Nursing Care Plans
Profile photo of Matt Vera, RN
Matt Vera, RN
http://nurseslabs.com
Matt Vera is a registered nurse and one of the main editors for Nurseslabs.com. Enjoys health
technology and innovations about nursing and medicine, in general.
RELATED ARTICLESMORE FROM AUTHOR

9 Parkinson’s Disease Nursing Care Plans

13 Alzheimer's Disease Nursing Care Plans
13 Alzheimer’s Disease Nursing Care Plans

Pharmacology: Neurologic and Psychiatric Drugs (30 Items)

Blood Test Predicts Alzheimer’s Years In Advance

Neurological Disorders NCLEX Practice Quiz 4 (30 Items)
Neurological Disorders NCLEX Practice Quiz 4 (30 Items)
Urolithiasis
4 Urolithiasis (Renal Calculi) Nursing Care Plans
NO COMMENTS

ADVERTISEMENT
LIKE US ON FACEBOOK
Nurseslabs
RECENT POSTS

5 Ways Patients Can Show Appreciation for Their Nurses

Rozzette Cabrera, RN - May 11, 2016 0
As it’s the celebration of Nurses Week, we’re outlining 5 of the best ways you, as patients, can
give the love and appreciation back to your nurses.

Heroes in White Caps: 7 Ways to Say Thank You to...

May 10, 2016

Careisma by Sofia Vergara Giveaway! Three Winners of Scrub Set of...

May 7, 2016

Giveaway: Celebrating ‘The Joy of Nursing: Reclaiming Our Nobility’

May 7, 2016

NurseWatches.com Giveaway! Three Lucky Winners of Nurse Watches!

May 6, 2016

Celebrating Nurses Week 2016

May 6, 2016
Nurses as Force for Change
Nurses as Force For Change: Celebrating International Nurses Day 2016

May 6, 2016

10 Gift Ideas for the Special Nurses in Your Life

May 5, 2016
ADVERTISEMENT

Welcome to Nurseslabs.com, a website dedicated For All Your Nursing Needs! If you have any
questions or inquiries, feel free to talk to us via our contact page
STAY CONNECTED
228,447FansLIKE
702FollowersFOLLOW
906FollowersFOLLOW
2,425FollowersFOLLOW
Subscribe to Blog via Email
Enter your email address to subscribe to this blog and receive notifications of new posts by
email.

Join 2,740 other subscribers

Email Address
Email Address

Subscribe

© 2016 Nurseslabs | Ut in Omnibus Glorificetur Deus!

About Suggestions? Disclaimer Privacy Policy Forums Shop

CLOSE
EXAMS
MNEMONICS
CARE PLANS
NOTES
CAREER
NEWS
LIFESTYLE
VIDEOS
Nurseslabs

Home Nursing Care Plans 9 Multiple Sclerosis Nursing Care Plans

NURSING CARE PLANS
9 Multiple Sclerosis Nursing Care Plans

By Matt Vera, RN - Mar 5, 2014 0

1k898Facebook1174
Multiple sclerosis (MS) is the most common of the demyelinating disorders and the predominant
CNS disease among young adults. MS is a progressive disease caused by demyelination of the
white matter of the brain and spinal cord. In this disease, sporadic patches of demyelination
throughout the central nervous system induce widely disseminated and varied neurologic
dysfunction. MS is characterized by exacerbations and remissions, MS is a major cause of
chronic disability in young adults.

The prognosis varies. MS may progress rapidly , disabling some patients by early adulthood or
causing death within months of onset. However, 70% of patients lead active, productive lives
with prolonged remissions.

The exact cause of MS is unknown, but current theories suggest a slow-acting or latent viral
infection and an autoimmune response. Other theories suggests that environmental and genetic
factors may also be linked to MS. Stress, fatigue, overworking, pregnancy or acute respiratory
tract infections have been known to precede the onset of this illness. MS usually begins
between ages 20 and 40. It affects more women than men.

Nursing Care Plans

The goal of treatment is to shorten exacerbations and relieve neurologic deficits so that the
patient can resume a normal lifestyle. With that, here are 9 multiple sclerosis nursing care plans
(NCP).

1. Fatigue

May be related to

Decreased energy production, 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; decreased performance
Impaired ability to concentrate; disinterest in surroundings
Increase in physical complaints
Desired Outcomes

Identify risk factors and individual actions affecting fatigue.

Identify alternatives to help maintain desired activity level.
Participate in recommended treatment program.
Report improved sense of energy.
Nursing Interventions Rationale
Note and accept presence of fatigue.Fatigue is 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.
Identify and review factors affecting ability to be active: temperature extremes, inadequate food
intake, insomnia, use of medications, time of day. Provides opportunity to problem-solve to
maintain or improve mobility.
Accept when patient is unable to do activities. 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.
Determine need for walking aids. Provide braces, walkers, or wheelchairs. Review safety
considerations. 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.
Schedule ADLs in the morning if appropriate. Investigate use of cooling vest. Fatigue
commonly worsens in late afternoon (when body temperature rises). Some patients report
lessening of fatigue with stabilization of body temperature.
Plan care consistent rest periods between activities. Encourage afternoon nap. Reduces
fatigue, aggravation of muscle weakness.
Assist with physical therapy. Increase patient comfort with massages and relaxing baths.
Reduces fatigue and promotes sense of wellness.
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 discouragement. In
time, patient can become very adept at knowing limitations.
Investigate appropriateness of obtaining a service dog. Service dogs can increase patient’s
level of independence. They can also assist in energy conservation by carrying items in “saddle”
bags and retrieving or performing tasks.
Recommend participation in groups involved in fitness or exercise and/or the Multiple Sclerosis
Society. Can help patient to stay motivated to remain active within the limits of the
disability or condition. Group activities need to be selected carefully to meet patient’s needs and
prevent discouragement or anxiety.
Administer medications as indicated:
Amantadine (Symmetrel); pemoline (Cylert) 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 and feet.
Methylphenidate (Ritalin), modafinil (Provigil) CNS stimulants that may reduce fatigue but
may also cause side effects of nervousness, restlessness, and insomnia.
Sertraline (Zoloft), fluoxetine (Prozac) 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: amitriptyline (Elavil), nortriptyline (Pamelor) Useful in treating
emotional lability, neurogenic pain, and associated sleep disorders to enhance willingness to be
more active.
Anticonvulsants: carbamazepine (Tegretol), gabapentin (Neurontin), lamotrigine (Lamictal)
Used to treat neurogenic pain and sudden intermittent spasms related to spinal cord irritation.
Steroids: prednisone (Deltasone), dexamethasone (Decadron), methyl-prednisolone
(Solu-Medrol) May be used during acute exacerbations to reduce and prevent edema formation
at the sclerotic plaques. Note: Long-term therapy seems to have little effect on progression of
symptoms.
Vitamin B Supports nerve-cell replication, enhances metabolic functions, and may increase
sense of well-being and energy level.
Immuno-modulating agents: cyclo phosphamide (Cytoxan), azathioprine (Imuran), methotrexate
(Mexate), interferon [beta]-1B (Betaseron); interferon [beta]-1A (Avonex, Rebif), glatiramer
(Copaxone); mitoxantrone (Novantrone). May be used to treat acute relapses, reduce the
frequency of relapse, and promote remission. Interferon [beta]-1B (Betaseron) has been
approved for use by ambulatory patients with remitting relapsing MS and is the first drug found
to alter the course of the disease. Current research indicates early treatment with drugs that
reduce inflammation and lesion formation may limit permanent damage. Therapy of choice is “A,
B, C” drugs: Avonex, Betaseron, and Copaxone. Therapeutic benefits have been reported in
patients at all stages of disability with reduction in both steroid use and hospital days.
(Copaxone chemically resembles a component of myelin and may act as a decoy, 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.
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. Self-care Deficit

May be related to

Neuromuscular/perceptual impairment; intolerance to activity; decreased strength and

endurance; motor impairment, tremors
Pain, discomfort, fatigue
Memory loss
Depression
Possibly evidenced by

Frustration; inability to perform tasks of self-care, poor personal hygiene

Desired Outcomes

Identify individual areas of weakness/needs.

Demonstrate techniques/lifestyle changes to meet self-care needs.
Perform self-care activities within level of own ability.
Identify personal/community resources that provide assistance.
Nursing Interventions Rationale
Determine current activity level and physical condition. Assess degree of functional impairment
using 0–4 scale. Provides information to develop plan of care for rehabilitation. Note: Motor
symptoms are less likely to improve than sensory ones.
Encourage patient to perform self-care to the maximum of ability as defined by patient. Do not
rush patient. Promotes independence and sense of control; may decrease feelings of
helplessness.
Assist according to degree of disability; allow as much autonomy as possible. Participation
in own care can ease the frustration over loss of independence.
Encourage patient input in planning schedule. Patient’s quality of life is enhanced when
desires and likes are considered in daily activities.
Note presence of fatigue. Fatigue experienced by patients with MS can be very debilitating
and greatly impact ability to participate in ADLs. The subjective nature of reports of fatigue can
be misinterpreted by healthcare providers and family, leading to conflict and the belief that the
patient is “manipulative” when, in fact, this may not be the case.
Encourage scheduling activities early in the day or during the time when energy level is best.
Patients with MS expend a great deal of energy to complete ADLs, increasing the risk of fatigue,
which often progresses through the day.
Allot sufficient time to perform tasks, and display patience when movements are slow.
Decreased motor skills and spasticity may interfere with ability to manage even simple activities.
Anticipate hygienic needs and calmly assist as necessary with care of nails, skin, and hair;
mouth care; shaving. 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.
Provide assistive devices and aids as indicated: shower chair, elevated toilet seat with arm
supports. Reduces fatigue, enhancing participation in self-care.
Reposition frequently when patient is immobile (bed or chair bound). Provide skin care to
pressure points, such as sacrum, ankles, and elbows. Position properly and encourage to sleep
prone as tolerated. Reduces pressure on susceptible areas, prevents skin breakdown.
Minimizes flexor spasms at knees and hips.
Provide massage and active or passive ROM exercises on a regular schedule. Encourage use
of splints or footboards as indicated. Prevents problems associated with muscle dysfunction and
disuse. Helps maintain muscle tone and strength and joint mobility, and decreases risk of loss of
calcium from bones.
Encourage stretching and toning exercises and use of medications, cold packs, and splints and
maintenance of proper body alignment, when indicated. Helps decrease spasticity and its
effects.
Problem-solve ways to meet nutritional and fluid needs. Provides for adequate intake and
enhances patient’s feelings of independence or self-esteem.
Consult with physical and/or occupational therapist. Useful in identifying devices and/or
equipment to relieve spastic muscles, improve motor functioning, prevent and reduce muscular
atrophy and contractures, promoting independence and increasing sense of self-worth.
Administer medications as indicated:
Tizanidine (Zanaflex), baclofen (Lioresal), carbamazepine (Tegretol); Newer drugs used for
reducing spasticity, promoting muscle relaxation, and inhibiting reflexes at the spinal nerve root
level. Enhance mobility and maintenance of activity. Tizanidine (Zanaflex) may have an additive
effect with baclofen (Lioresal), but use with caution because both drugs have similar side
effects. Short duration of action requires careful individualizing of dosage to maximize
therapeutic effect.
Diazepam (Valium), clonazepam (Klonopin), cyclobenzaprine (Flexeril), gabapentin (Neurontin,
dantrolene (Dantrium); A variety of medications are used to reduce spasticity. The
mechanisms are not well understood, and responses vary in each person. Therefore, it may
take a period of medication trials to discover what provides the most effective relief of muscle
spasticity and associated pain. Note: Adverse effects may be increased muscle weakness, loss
of muscle tone, and liver toxicity.
Meclizine (Antivert), scopolamine patches (Transderm-Scop). Reduces dizziness, allowing
patient to be more mobile.
3. Low Self-Esteem

May be related to

Change in structure/function
Disruption in how patient perceives own body
Role reversal; dependence
Possibly evidenced by

Confusion about sense of self, purpose, direction in life

Denial, withdrawal, 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.

View self as a capable person.
Participate in and assume responsibility for meeting own needs.
Recognize and incorporate changes in self-concept/role without negating self-esteem.
Develop realistic plans for adapting to role changes.
Nursing Interventions Rationale
Establish and maintain a therapeutic nurse-patient relationship, discussing fears and concerns.
Conveys an attitude of caring and develops a sense of trust between patient and caregiver in
which patient is free to express fears of rejection, loss of previous functioning and/or
appearance, feelings of helplessness, powerlessness about changes that may occur. Promotes
a sense of well-being for patient.
Note withdrawn behaviors and use of denial or over concern with body and disease process.
Initially may be a normal protective response, but if prolonged, may prevent dealing
appropriately with reality and may lead to ineffective coping.
Support use of defense mechanisms, allowing patient to deal with information in own time and
way. Confronting patient with reality of situation may result in increased anxiety and lessened
ability to cope with changed self-concept/role.
Acknowledge reality of grieving process related to actual or perceived changes. Help patient
deal realistically with feelings of anger and sadness. Nature of the disease leads to
ongoing losses and changes in all aspects of life, blocking resolution of grieving process.
Review information about course of disease, possibility of remissions, prognosis. When patient
learns about disease and becomes aware that own behavior (including feeling hopeful/
maintaining a positive attitude) can significantly improve general well-being and daily
functioning, patient may feel more in control, enhancing sense of self-esteem. Note: Some
patients may never have a remission.
Provide accurate verbal and written information about what is happening and discuss with
patient/SO. Helps patient stay in the “here and now,” reduces fear of the unknown; provides
reference source for future use.
Explain that labile emotions are not unusual. Problem-solve ways to deal with these feelings.
Relieves anxiety and assists with efforts to manage unexpected emotional displays.
Note presence of depression and impaired thought processes, expressions of suicidal ideation
(evaluate on a scale of 1–10). Adapting to a long-term, progressively debilitating
incurable disease is a difficult emotional adjustment. In addition, cognitive impairment may
affect adaptation to life changes. A depressed individual may believe that suicide is the best
way to deal with what is happening.
Assess interaction between patient and SO. Note changes in relationship. SO may
unconsciously or consciously reinforce negative attitudes and beliefs of patient, or issues of
secondary gain may interfere with progress and ability to manage situation.
Provide open environment for patient and SO to discuss concerns about sexuality, including
management of fatigue, spasticity, arousal, and changes in sensation. Physical and
psychological changes often create stressors within the relationship, affecting usual roles and
expectations, further impairing self-concept.
Discuss use of medications and adjuncts to improve sexual function. Patient and partner
may want to explore trial of medications (papaverine [Pavabid], dinoprostone [Prostin E2]) or
other avenues of improving sexual relationship.
Consult with occupational therapist/ rehabilitation team. Identifying assistive devices and/or
equipment enhances level of overall function and participation in activities, enhancing sense of
well-being and viewing self as a capable individual.
4. Powerlessness/Hopelessness

Nursing Diagnosis

Powerlessness
Hopelessness
May be related to
Illness-related regimen, 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, decreased verbalization/affect
Verbal cues
Lack of involvement in care/passively allowing care
Isolating behaviors/social withdrawal
Desired Outcomes

Identify and verbalize feelings.

Use coping mechanisms to counteract feelings of hopelessness.
Identify areas over which individual has control.
Participate/monitor and control own self-care and ADLs within limits of the individual situation.
Nursing Interventions Rationale
Note behaviors indicative of powerlessness or hopelessness. Patient may say statements of
despair. The degree to which patient believes own situation is hopeless, that he or she is
powerless to change what is happening, affects how patient handles life situation.
Acknowledge reality of situation, at the same time expressing hope for 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 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, patient has a sense of control over own circumstances.
Determine degree of mastery patient has exhibited in life to the present. Note locus of control.
Patient who has assumed responsibility in life previously tends to do the same during difficult
times of exacerbation of illness. However, if locus of control has been focused outward, patient
may blame others and not take control over own circumstances.
Assist patient to identify factors that are under 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 individual can control.
Encourage patient to assume control over as much of own care as possible. Even when
unable to do much physical care, 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 patient feels powerless and not listened to.
Incorporate patient’s daily routine into home care schedule or hospital stay, as possible.
Maintains sense of control and self-determination and independence.
Refer to vocational rehabilitation as indicated. Can assist patient to develop and
implement a vocational plan incorporating specific interests and/or abilities.
Identify community resources. Participation in structured activities can reduce sense of
isolation and may enhance feeling of self-worth.
5. Risk for Ineffective Coping

Risk factors may include

Physiological changes (cerebral and spinal lesions)

Psychological conflicts; anxiety; fear
Impaired judgment, short-term memory loss; confusion; unrealistic perceptions/ expectations,
emotional lability
Personal vulnerability; inadequate support systems
Multiple life changes
Inadequate coping methods
Possibly evidenced by

Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has
not occurred and nursing interventions are directed at prevention.
Desired Outcomes

Recognize relationship between disease process (cerebral lesions) and emotional responses,
changes in thinking/behavior.
Verbalize awareness of own capabilities/strengths.
Display effective problem-solving skills.
Demonstrate behaviors/lifestyle changes to prevent/minimize changes in mentation and
maintain reality orientation.
Nursing Interventions Rationale
Assess current functional capacity and limitations; note presence of distorted thinking
processes, labile emotions, cognitive dissonance. Note how these affect the individual’s coping
abilities. Organic or psychological effects may cause patient to be easily distracted, to
display difficulties with concentration, problem solving, dealing with what is happening, being
responsible for own care.
Determine patient’s understanding of current situation and previous methods of dealing with
life’s problems. Provides a clue as to how patient may deal with what is currently
happening, and helps identify individual resources and need for assistance.
Discuss ability to make decisions, care for children or dependent adults, handle finances.
Identify options available to individuals involved. Impaired judgment, confusion, inadequate
support systems may interfere with ability to meet own needs and needs of others.
Conservatorship, guardianship, or adult protective services may be required until (if ever)
patient is able to manage own affairs.
Maintain an honest, reality-oriented relationship. Reduces confusion and minimizes painful,
frustrating struggles associated with adaptation to altered environment or lifestyle.
Encourage verbalization of feelings and/or fears, accepting what patient says in a
nonjudgmental manner. Note statements reflecting powerlessness, inability to cope. May
diminish patient’s fear, establish trust, and provide an opportunity to identify problems and begin
the problem-solving process.
Observe nonverbal communication: posture, eye contact, movements, gestures, and use of
touch. Compare with verbal content and verify meaning with patient as appropriate. May
provide significant information about what patient is feeling; however, verification is important to
ensure accuracy of communication. Discrepancy between feelings and what is being said can
interfere with ability to cope, problem-solve.
Provide clues for orientation: calendars, clocks, notecards, organizers. These serve as
tangible reminders to aid recognition and permeate memory gaps and enable patient to cope
with situation.
Encourage patient to tape-record important information and listen to the recording periodically.
Repetition puts information in long-term memory, where it is more easily retrieved and can
support decision-making and problem-solving process.
Refer to cognitive retraining program. Improving cognitive abilities can enhance basic
thinking skills when attention span is short; ability to process information is impaired; patient is
unable to learn new tasks; or insight, judgment, and problem-solving skills are impaired.
Refer to counseling, psychiatric clinical nurse specialist and/or psychiatrist, as indicated. May
need additional help to resolve issues of self-esteem and regain effective coping skills.
Administer medications as appropriate: amitriptyline (Elavil); bupropion (Wellbutrin); imipramine
(Tofranil); Medications to improve mood and restful sleep may be useful in combating
depression and relieving degree of fatigue interfering with function.
6. Ineffective Family Coping

May be related to

Situational crisis; 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, anxiety, hostility, 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.
SO preoccupied with own personal reactions
Intolerance, abandonment
Neglectful care of patient
Distortion of reality regarding patient’s illness
Desired Outcomes

Identify/verbalize resources within themselves to deal with the situation.

Express more realistic understanding and expectations of patient.
Interact appropriately with patient/healthcare providers providing support and assistance as
indicated.
Verbalize knowledge and understanding of disability/disease and community resources.
Nursing Interventions Rationale
Note length, severity of illness. Determine patient’s role in family and how illness has changed
the family organization. Chronic illness, accompanied by changes in role performance and
responsibility, often exhausts supportive capacity and coping abilities of SO or family.
Determine SO’s understanding of disease process and expectations for the future.
Inadequate information and misconception regarding disease process and/or unrealistic
expectations affect ability to cope with current situation. Note: A particular area of misconception
is the fatigue experienced by patients with MS. Family members may view patient’s inability to
perform activities as manipulative behavior rather than an actual physiological deficit.
Discuss with SO/family members their willingness to be involved in care. Identify other
responsibilities and factors impacting participation. Individuals may not have desire or time to
assume responsibility for care. If several family members are available, they may be able to
share tasks.
Assess other factors that are affecting abilities of family members to provide needed support.
Individual members’ preoccupation with own needs and concerns can interfere with providing
needed care and support for stresses of long-term illness. Additionally, caregiver(s) may incur
decrease or loss of income or risk losing own health insurance if they alter their work hours.
Discuss underlying reasons for patient’s behaviors. Helps SO understand and accept and deal
with behaviors that may be triggered by emotional or physical effects of MS.
Encourage patient and SO to develop and strengthen problem-solving skills to deal with
situation. Family may or may not have handled conflict well before illness, and stress of
long-term debilitating condition can create additional problems (including unresolved anger).
Encourage free expression of feelings, including frustration, anger, hostility, and hopelessness.
Individual members may be afraid to express “negative” feelings, believing it will discourage
patient. Free expression promotes awareness and can help with resolution of feelings and
problems (especially when done in a caring manner).
Identify community resources and local MS organization, support groups, home care agencies,
respite programs. Provides information, opportunities to share with others who are
experiencing similar difficulties, and sources of assistance when needed.
Refer to social worker, financial adviser, psychiatric clinical nurse specialist and psychiatrist as
appropriate. May need more in-depth assistance from professional sources.
7. Impaired Urinary Elimination

May be related to
Neuromuscular impairment (spinal cord lesions/neurogenic bladder)
Possibly evidenced by

Incontinence; nocturia; frequency

Retention with overflow
Recurrent UTIs
Desired Outcomes

Verbalize understanding of condition.

Demonstrate behaviors/techniques to prevent/minimize infection.
Empty bladder completely and regularly (voluntarily or by catheter as appropriate).
Be free of urine leakage.
Nursing Interventions Rationale
Note reports of urinary frequency, urgency, burning, incontinence, nocturia, and size or force of
urinary stream. Palpate bladder after voiding. Provides information about degree of
interference with elimination or may indicate bladder infection. Fullness over bladder following
void is indicative of inadequate emptying or retention and requires intervention.
Review drug regimen, including prescribed, over-the-counter (OTC), and street. A number of
medications such as some antispasmodics, antidepressants, and narcotic analgesics; OTC
medications with anticholinergic or alpha agonist properties; or recreational drugs such as
cannabis may interfere with bladder emptying.
Institute bladder training program or timed voidings as appropriate.Helps restore adequate
bladder functioning; lessens occurrence of incontinence and bladder infection.
Encourage adequate fluid intake, avoiding caffeine and use of aspartame, and limiting intake
during late evening and at bedtime. Recommend use of cranberry juice/ vitamin C.
Sufficient hydration promotes urinary output and aids in preventing infection. Note: When patient
is taking sulfa drugs, sufficient fluids are necessary to ensure adequate excretion of drug,
reducing risk of cumulative effects. Note: Aspartame, a sugar substitute (e.g., Nutrasweet), may
cause bladder irritation leading to bladder dysfunction.
Promote continued mobility. Decreases risk of developing UTI.
Recommend good hand washing and proper perineal care. Reduces skin irritation and risk of
ascending infection.
Encourage patient to observe for sediments or blood in urine, foul odor, fever, or unexplained
increase in MS symptoms. Indicative of infection requiring further evaluation or treatment.
Refer to urinary continence specialist as indicated. Helpful for developing individual plan of care
to meet patient’s specific needs using the latest techniques, continence products.
Administer medications as indicated:
Oxybutynin (Ditropan), propantheline (Pro-Banthine), hyoscyamine sulfate (Cytospaz-M),
flavoxate hydrochloride (Urispas), tolterodine (Detrol). Reduce bladder spasticity and
associated symptoms of frequency, urgency, incontinence, nocturia.
Catheterize as indicated. May be necessary as a treatment and for evaluation if patient is
unable to empty bladder or retains urine.
Teach self-catheterization and instruct in use and care of indwelling catheter. Helps patient
maintain autonomy and encourages self-care. Indwelling catheter may be required, depending
on patient’s abilities and degree of urinary problem.
Obtain periodic urinalysis and urine culture and sensitivity as indicated. Monitors renal status.
Colony count over 100,000 indicates presence of infection requiring treatment.
Administer anti-infective agents as necessary:
Nitrofurantoin macrocrystals. (Macrodantin); co-trimoxazole (Bactrim, Septra); ciprofloxacin
(Cipro); norfloxacin (Noroxin). Bacteriostatic agents that inhibit bacterial growth and
destroy susceptible bacteria. Prompt treatment of infection is necessary to prevent serious
complications of sepsis/shock
8. Knowledge Deficit

May be related to

Lack of exposure; information misinterpretation

Unfamiliarity with information resources
Cognitive limitation, lack of recall
Possibly evidenced by

Statement of misconception
Request of information
Inaccurate follow-through of instruction; development of preventable complications
Inappropriate or exaggerated behaviors (e.g., hysterical, hostile, agitated, apathetic)
Desired Outcomes

Participate in learning process.

Assume responsibility for own learning and begin to look for information and to ask questions.
Verbalize understanding of condition/disease process and treatment.
Initiate necessary lifestyle changes.
Participate in prescribed treatment regimen.
Nursing Interventions Rationale
Evaluate desire and readiness of patient and SO and/or caregiver to learn. Determines
amount or level of information to provide at any given moment.
Note signs of emotional lability or whether patient is in dissociative state (loss of affect,
inappropriate emotional responses). Patient will not process or retain information and will have
difficulty learning during this time.
Provide information in varied formats depending on patient’s cognitive or perceptual abilities and
considering patient’s locus of control. Changes in cognitive, visual, auditory function
impact choice of teaching modalities: verbal instruction, books, pamphlets, audiovisuals,
computer programs. Whether locus of control is internal or external affects patient’s attitude
toward helpfulness of learning.
Encourage active participation of patient or SO in learning process, including use of self-paced
instruction as appropriate. Enhances sense of independence and control and may strengthen
commitment to therapeutic regimen.
Review disease process or prognosis, effects of climate, emotional stress, overexertion, fatigue.
Clarifies patient or SO understanding of individual situation.
Identify signs and symptoms requiring further evaluation. Prompt intervention may help limit
severity of exacerbation or complications.
Discuss importance of daily routine of rest, exercise, activity, and eating, focusing on current
capabilities. Instruct in use of appropriate devices to assist with ADLs, e.g., eating utensils,
walking aids. Helps patient maintain current level of physical independence and may limit
fatigue.
Stress necessity of weight control. Excess weight can interfere with balance and motor
abilities and make care more difficult.
Review possible problems that may arise, such as decreased perception of heat and pain,
susceptibility to skin breakdown and infections, especially UTI. These effects of
demyelination and associated complications may compromise patient safety and/or precipitate
an exacerbation of symptoms.
Identify actions that can be taken to avoid injury, e.g., avoid hot baths, inspect skin regularly,
take care with transfers and wheelchair/ walker mobility, force fluids, and get adequate nutrition.
Encourage avoidance of persons with upper respiratory infection. Review of risk factors can
help patient take measures to maintain physical state at optimal level/prevent complications.
Discuss increased risk of osteoporosis and review preventive measures, e.g., regular exercise,
intake of calcium and vitamin D, reduced intake of caffeine, cessation of smoking, hormone
replacement therapy (HRT) or alternatives (e.g., bisphosphonates—Fosamax), and fall
prevention measures such as wearing low-heeled shoes with nonskid soles, use of handrails/
grab bars in bathroom and along stairwells, removal of small area rugs. Decreased mobility,
vitamin D deficiency (possibly a result increased of decreased exposure to sunlight, which can
exacerbate MS symptoms), and decreased likelihood of engaging in preventive measures
increase bone mass loss and the risk of fractures.
Identify bowel elimination concerns. Recommend adequate hydration and intake of fiber; use of
stool softeners, bulking agents, suppositories, or possibly mild laxatives; bowel training
program. Constipation is common, and bowel urgency and/or accidents may occur as a
result of dietary deficiencies or impaction.
Review specifics of individual medications. Recommend avoidance of OTC drugs.
Reduces likelihood of drug interactions and/or adverse effects, and enhances cooperation with
treatment regimen.
Discuss concerns regarding sexual relationships, contraception and reproduction, effects of
pregnancy on affected woman. Identify alternative ways to meet individual needs; counsel
regarding use of artificial lubrication (females), genitourinary (GU) referral for males regarding
available medication and sexual aids. Pregnancy may be an issue for the young patient
relative to issues of genetic predisposition and/or ability to manage pregnancy or parent
offspring. Increased libido is not uncommon and may require adjustments within the existing
relationship or in the absence of an acceptable partner. Information about different positions and
techniques and/or other options for sexual fulfillment (e.g., fondling, cuddling) may enhance
personal relationship and feelings of self-worth.
Encourage patient to set goals for the future while focusing on the “here and now,” what can be
done today. Having a plan for the future helps retain hope and provides opportunity for patient
to see that although today is to be lived, one can plan for tomorrow even in the worst of
circumstances.
Identify financial concerns. Loss or change of employment (for patient and/or SO) impacts
income, insurance benefits, and level of independence, requiring additional family and social
support.
Refer for vocational rehabilitation as appropriate. May need assessment of capabilities and
job retraining as indicated by individual limitations and disease progression.
Recommend contacting local and national MS organizations, relevant support groups.
Ongoing contact (e.g., mailings) informs patient of programs and services available, and can
update patient’s knowledge base. Support groups can provide role modeling, sharing of
information and enhance problem-solving ability.
9. Risk for Caregiver Role Strain

Risk factors may include

Severity of illness of the care receiver, duration of caregiving required,

complexity/amount of caregiving task
Caregiver is female, spouse
Care receiver exhibits deviant, bizarre behavior
Family/caregiver isolation; lack of respite and recreation
Desired Outcomes

Identify individual risk factors and appropriate interventions.

Demonstrate/initiate behaviors or lifestyle changes to prevent development of impaired function.
Use available resources appropriately.
Report satisfaction with plan and support available.
Nursing Interventions Rationale
Note physical/mental condition, therapeutic regimen of care receiver. Determines individual
needs for planning care. Identifies strengths and how much responsibility patient may be
expected to assume, as well as disabilities requiring accommodation.
Determine caregiver’s level of commitment, responsibility, involvement in and anticipated length
of care. Use assessment tool, such as Burden Interview, to further determine caregiver’s
abilities, when appropriate. Progressive debilitation taxes caregiver and may alter ability to
meet patient or own needs.
Discuss caregiver’s view of and about situation. Allows ventilation and clarification of
concerns, promoting understanding.
Determine available supports and resources currently used. Organizations can provide
information regarding adequacy of supports and identify needs.
Facilitate family conference to share information and develop plan for involvement in care
activities as appropriate. When others are involved in care, the risk of one person’s
becoming overloaded is lessened.
Identify additional resources to include financial, legal assistance. These areas of concern can
add to burden of caregiving if not adequately resolved.
Identify adaptive equipment needs and resources for the home and vehicles. Enhances
independence and safety of both caregiver and patient.
Provide information and/or demonstrate techniques for dealing with acting-out or violent or
disoriented behavior. Helps caregiver maintain sense of control and competency. Enhances
safety for care receiver and caregiver.
Stress importance of self-nurturing: pursuing self-development interests, personal needs,
hobbies, and social activities. Taking time for self can lessen risk of “burnout”/being
overwhelmed by situation.
Identify alternate care sources (such as sitter or day care facility), senior care services, home
care agency. As patient’s condition worsens, SO may need additional help from several
sources to maintain patient at home even on a part-time basis.
Assist caregiver to plan for changes that may be necessary for the care receiver (eventual
placement in extended care facility). Planning for this eventually is important for the time when
burden of care becomes too great.
Refer to supportive services as need indicates. Medical case manager or social services
consultant may be needed to develop ongoing plan to meet changing needs of patient and
SO/family.
Other Possible Nursing Care Plans

Trauma, risk for—weakness, poor vision, balancing difficulties, reduced temperature/tactile

sensation, reduced muscle and hand/eye coordination, cognitive or emotional difficulties,
insufficient finances to purchase necessary equipment.
Home Maintenance, impaired—insufficient finances, unfamiliarity with neighborhood resources,
inadequate support systems.
Disuse Syndrome, risk for/[actual]—paralysis/immobilization, severe pain.
Therapeutic Regimen: ineffective management—economic difficulties, family conflict, social
support deficits.
See Also

Nursing Care Plans

1k898Facebook1174

TAGSCENTRAL NERVOUS SYSTEMDEGENERATIVE

DISEASESFATIGUEHOPELESSNESSIMPAIRED URINARY ELIMINATIONINEFFECTIVE
FAMILY COPINGKNOWLEDGE DEFICITLOW SELF-ESTEEMPOWERLESSNESSRISK FOR
CAREGIVER ROLE STRAINRISK FOR INEFFECTIVE COPINGSELF-CARE DEFICIT
Previous article
Cancer and Oncology Nursing NCLEX Practice Quiz 3 (25 Items)
Next article
5 Total Joint (Knee, Hip) Replacement Nursing Care Plans
Profile photo of Matt Vera, RN
Matt Vera, RN
http://nurseslabs.com
Matt Vera is a registered nurse and one of the main editors for Nurseslabs.com. Enjoys health
technology and innovations about nursing and medicine, in general.
RELATED ARTICLESMORE FROM AUTHOR

9 Parkinson’s Disease Nursing Care Plans

13 Alzheimer's Disease Nursing Care Plans
13 Alzheimer’s Disease Nursing Care Plans

Pharmacology: Neurologic and Psychiatric Drugs (30 Items)

Blood Test Predicts Alzheimer’s Years In Advance

Neurological Disorders NCLEX Practice Quiz 4 (30 Items)
Neurological Disorders NCLEX Practice Quiz 4 (30 Items)
Urolithiasis
4 Urolithiasis (Renal Calculi) Nursing Care Plans
NO COMMENTS

ADVERTISEMENT
LIKE US ON FACEBOOK
Nurseslabs
RECENT POSTS

5 Ways Patients Can Show Appreciation for Their Nurses

Rozzette Cabrera, RN - May 11, 2016 0
As it’s the celebration of Nurses Week, we’re outlining 5 of the best ways you, as patients, can
give the love and appreciation back to your nurses.

Heroes in White Caps: 7 Ways to Say Thank You to...

May 10, 2016

Careisma by Sofia Vergara Giveaway! Three Winners of Scrub Set of...

May 7, 2016

Giveaway: Celebrating ‘The Joy of Nursing: Reclaiming Our Nobility’

May 7, 2016

NurseWatches.com Giveaway! Three Lucky Winners of Nurse Watches!

May 6, 2016

Celebrating Nurses Week 2016

May 6, 2016
Nurses as Force for Change
Nurses as Force For Change: Celebrating International Nurses Day 2016

May 6, 2016

10 Gift Ideas for the Special Nurses in Your Life

May 5, 2016
ADVERTISEMENT

Welcome to Nurseslabs.com, a website dedicated For All Your Nursing Needs! If you have any
questions or inquiries, feel free to talk to us via our contact page
STAY CONNECTED
228,447FansLIKE
702FollowersFOLLOW
906FollowersFOLLOW
2,425FollowersFOLLOW
Subscribe to Blog via Email
Enter your email address to subscribe to this blog and receive notifications of new posts by
email.

Join 2,740 other subscribers

Email Address
Email Address

Subscribe

© 2016 Nurseslabs | Ut in Omnibus Glorificetur Deus!

About Suggestions? Disclaimer Privacy Policy Forums Shop