Managing Self-Care Deficit in Patients with Multiple Sclerosis: A Nursing Care Plan

This paper discusses the case of a patient diagnosed with multiple sclerosis and suffering from social isolation. Using the clinical reasoning cycle, the top priorities of nursing care plans for managing multiple sclerosis are identified. The focus is on self-care deficit and the use of self-management interventions to improve psychological well-being. The paper also includes goals, actions, evaluation of outcomes, and reflection. Subject: Nursing, Course Code: NURS, College/University: Not mentioned.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student:
Name of the University:
Author Note:

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Introduction
Multiple sclerosis is an immune-mediated disorder that is progressive in nature. The
immune system that is designed to keep the body healthy instead attacks the body parts that are
vital for the proper functioning of the body system. This disease has several unpredictable
symptoms which can be of varying intensity. Some of the patients are seen to experience
numbness and fatigue, while there are several cases where the patients suffer from paralysis, loss
of vision along with reduction of brain functions (Asano & Finlayson, 2014). This paper aims to
discuss the case of a patient who has been diagnosed with multiple sclerosis and has been
suffering from social isolation hence is need of proper nursing care plans. With the help of the
clinical reasoning of the cycle, the top priorities of nursing used to manage the patients suffering
from multiple sclerosis have been identified. Management of self care deficit has been identified
in this study, which can be improved using self management interventions. These self
management interventions have proved to be helpful for such patients as they have shown to
decrease the anxiety and depression in patients hence improving their psychological well-being.
Part A
The clinical reasoning cycle is used for the following assessment. The clinical reasoning
cycle is an important process by which nurses and the clinicians is able to collect cues and
process the information. Through this they come to an understanding of a patient problem or
situation, plan and implement interventions, evaluate outcomes, and reflect on and learn from the
process (Levett-Jones, 2013).

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1. Consider the patient
The patient here is Mr. Dinh Nguyen, who is a widower of 83 years old. Six years ago he had
been diagnosed with Multiple Sclerosis. He was further diagnosed with osteoarthritis four years
ago, however right now it was controlled on medication. In the year 1976, Nguyen’s migrated
from Vietnam.
Dinh currentlylives alone in his own two story home where previously he had lived with his
wife, Ngoc. However she had died twelve months ago. Dinh remained independent after the
death of his wife. However with the increase of his grief, his isolation had increased. There was a
marked decline in his health along with the worsening of his exacerbations due to MS. Dinh and
Ngoc were childless, therefore Dinh had no immediate family. However, Dinh had a brother,
Bao, who along with his family lived close by. However Dinh had no desire to get involved with
them and did not want bother them.Dinh had a small income whoch he received from his self-
managed superannuation therefore was careful enough with his money. His finances were just
enough to cover his expenses. He took vacations once every year, however this year he was
unable to do so due to his impaired mobility.
2. Collect cues/information
Apart from being diagnosed with multiple sclerosis, he was also diagnosed with
osteoarthritis. He suffered from other disorders like some blurred vision along with face
numbness that occurred often. Additionally he often had sensations like “electric shock” while
moving his head and neck. This sensation often travelled down his back and into his legs. This
impacted his mobility and gait in a severe manner. This is making his daily tasks difficult like
cooking, bathing and dressing. Acts like bending down to do up his shoe laces have become most

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difficult to perform. There were also certain episodes of urinary incontinence which Dinh had
started experiencing lately. Dinh has perceived that the process of his disease is gradually
worsening. Therefore he is starting to be apprehensive that how will he able to face the
uncertainty of his future. He is currently on medications like Panadol Osteo 4/24 Oral prn
(maximum 8 per day), Teriflunomide 14mg Oral daily and Prednisolone 25mg Oral BD (during
an exacerbation).
3. Process information
The information related to the health of the patient provides evidence that he had been
suffering from multiple sclerosis. The patient had shown blurred vision that are some early signs
of MS. Additionally symptoms like numbness of the face, bladder issues, pains and spasms,
dizziness and balance problems, along with cognitive problems (Belbasis et al., 2015). All of this
signs and symptoms were portrayed by Dinh which were related to multiple sclerosis. Most
probably the absence of children was related to sexual dysfunction which is another sign of
multiple sclerosis. In accordance to the functional consequences theory, the following factors can
be considered in relation to multiple sclerosis. There are the age related changes, the risk factors
and the negative functional consequences. The factor of ageing is quite significant in the course
of multiple sclerosis. Literature shows that the individuals who are over the age of 65 years are
more likely to have a progressive course showimg primary progressive (PP), 29%. Additionally
secondary progressive (SP) is 26% along with progressive relapsing (PR) showing 8%. In
comparison to the younger counterparts,there are 57% have relapsing-remitting multiple
sclerosis (RRMS) (Dendrou, Fugger& Friese, 2015).

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4. Identify problems/issues
Multiple sclerosis is one of the most common disorders that is demyelinating and is a
predominant disease of the central nervous system, occurring especially in the young adults. It is
a kind of progressive disease that is caused due to demyelination occurring in the white matter of
the brain as well as the spinal cord (Gold., 2013). The top priorities in managing multiple
sclerosis are to shorten the exacerbations along with relieving of the neurological deficits, in
order to make the patient resume a standard lifestyle. Some of the nursing care plans that can be
adopted to reduce the problems of multiple sclerosis include fatigue, deficit of self-care,
lowering of self-esteem. Additionally cure for powerlessness and hopelessness, coping the risk of
ineffective, coping of family ineffectiveness with elimination of urinary impairment (Kidd et al.,
2017). In addition to this, management should be done for knowledge deficiency, risk for role
strains of caregivers and other nursing care plans.
Part B
5. Establish goals
Considering the top priorities of nursing care plan, for this study the issue of self-care deficit
has been chosen. Goals are needed to be established in order to promote self-management
interventions in the day to day life of the patients. With the help of chronic care model, the self-
management strategies can be developed. Goals should be implemented in way which will
enable the patient to manage their own health and this support must be provided by the
physicians and other healthcare providers (Olsson, Barcellos & Alfredsson, 2017). The goal
should be clearly defined. Here the goal is to promote self-management by chronic care model.

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This will be measured by checking the patient’s recovery time to time.The goal is achievable as
she is curing the patient using therapy. The goal is realistic in nature as the time limit is set,
hence it is time bound.
6. Take action
The self-management tasks might include medical symptoms management through which
medications must be taken properly, adhering to the diet that is prescribed. Use of medical
devises must be followed and life hygiene actions should be implemented like proper sleep and
exercises. There should be role management, by creation and maintenance of new and
meaningful behaviors within the life roles, which includes change of responsibilities within the
family. Finally there emotional management should be undertaken. Situations of induced
emotions must be handled properly that includes depression along with grief, fear and anger.
Interventions include remote, deliver, face to face support, cognitive behavioral group
interventions along with chronic disease self management course, motivational interview and
telephone counseling and health promotion education program (Ma, Chan &Carruthers, 2014).
7. Evaluate outcomes
The self management interventions adopted for the patients suffering from multiple sclerosis
helped the patients to improve their psychological well-being. There were evident improvements
in terms of anxiety and depression decrease. There was increased in knowledge of patient that
was related to the facilitators and the probable barriers associated with the success of self
management interventions (Lublin., 2014). This can help the development of customized

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interventions those arebased on individual profiles of the patient and their preferences. These
include face to face and the remote delivery. There is also a need to consider the role of
caregivers in future for the development of self management interventions as they are often
required for theevident symptom management in individuals suffering from Multiple Sclerosis.
There is a significant amount of evidence in terms of psychological distress in the carers of
individuals with MS (Belbasis et al., 2015). However there has been no significant development
in terms of services and provisions required to ease the caregiver of the burden of these group of
people.
8. Reflection
The identification of self care deficit leads to the impairment of the ability to perform tasks
like bathing, dressing feeding or activities of toileting on their own. This leads to conditions like
frustration and poor personal hygiene. Therefore in order to manage such patients, I would try to
identify the area of weakness in the individuals. Additionally I will try to demonstrate the
techniques of lifestyle changes so the patients are able to meet their self care needs.
The nursing mediation which I will try to implement will incorporate the assurance of the
present movement level of the patient and their physical condition. I will urge the patient to
perform self-care to the most extreme of capacity as characterized by tolerant, however I will try
not to surge tolerant. Help will be provided as indicated by level of incapacity along with
permitting self-governance to a level that will be acceptable. I will try to contribution towards
arranging a plan (Gunn et al., 2013). It is required to note the presence of fatigue at proper
intervals. Support booking exercises at early hour in the day or between the times when vitality
level is ideal. Adequate time needs to be allocated to perform tasks, and show persistence when

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developments are slow. It is required to envision clean needs for the patients and smoothly help
as important with care of nails, skin, and hair; mouth mind; shaving. Provision of assistive
devices and helps like shower seat, lifted latrine situate with arm bolsters is required. I will like
to reposition the patient every now and again when tolerant is stable (bed or seat bound). Giving
of healthy skin to weight focuses, for example, sacrum, lower legs, and elbows (Sanai et al.,
2016). Position legitimately and energize resting inclined as endured. Energize extending and
conditioning activities and utilization of drugs, cool packs, and supports and upkeep of legitimate
body arrangement, when shown. Issue explains approaches to meet wholesome and liquid needs.
Counseling with physical as well as word related specialist will be conducted (Hunter, 2016).
Conclusion
From the above analyses using the clinical reasoning cycle, the pathophysiological and
the psychological conditions of the patient was identified. The risk factors along with the age
elated issues and the negative consequences were also identified. This study also helped to
identify the priorities of the nursing care plans that are needed to manage the patients suffering
from multiple sclerosis. Here the top priority was identified as self-care deficit for which the
interventions of self-management. These self-management interventions have proved to be
helpful for such patients as they have shown to decrease the anxiety and depression in patients
hence improving their psychological well-being.

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