Multiple Sclerosis: Nursing Care Priorities and Interventions

This article discusses nursing care priorities and interventions for patients with Multiple Sclerosis. It covers the goals, nursing interventions, and evaluation of outcomes for MS patients. The article also includes a case study of an 83-year-old patient with MS and osteoarthritis.

RUNNING HEAD: MULTIPLE SCLEROSIS 1
Multiple sclerosis
Name:
Institution:
Tutor:
Date:

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MULTIPLE SCLEROSIS
INTRODUCTION
Multiple Sclerosis (MS) is a condition that affects the brain and the spinal cord or the
nervous system and has the potential to lead to disability. It arises as a result of the immune
system attacking the myelin that protects the nerve fibers and this leads to difficulties in
communication between the brain and the body (Jacques & Lublin, 2015). The signs and
symptoms generally depend on the extent to which the nerves are damaged. Some notable signs
and symptoms however include fatigue, blurred vision and difficulties in the bladder functions
(Dendrou, Fugger, & Friese, 2015). In this assignment, there is a case study of a patient who is
likely to be suffering from MS. There will be presentation of the scenario, important information,
processing of the information, identification of problems, established goals, the nursing
interventions, evaluation, reflection and conclusion regarding the case study. This condition
commonly occurs in the older people. In this assignment, I will utilize the Millers Functional
Consequences Theory to identify the influences that impact old people and their level of
functioning. In so doing, I will utilize the Levett Jones Clinical Reasoning Cycle as the tool to
drive the whole process.
PART A: IDENTIFICATION OF THE THREE NURSING CARE PRIORITIES
THE PATIENT SCENARIO
The patient in this scenario is an 83 year old widower called Mr. Dinh Nguyen. The
patient was diagnosed with multiple sclerosis six years ago. He was also diagnosed with
osteoarthritis four years ago and currently he is on medication. The patient migrated from
Vietnam in 1976 and he currently lives alone in a two story home where he lived with his wife

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called Ngoc until her death twelve Months ago. Since then, the patient has been independent.
With the ongoing grief however, the patient has noticed that there is a decline in his general
health because of the worsening exercabations of the Multiple Sclerosis. Since Dinh and Ngoc
never had any child, he has no immediate family. He only has his brother who is called Bao and
his family that lives close to Dinh. The patient does not however feel like involving them in his
life as it will be a bother to them.
The patient is always very careful with his little money .He said that he has a small
income from his superannuation which he cares by himself. This gives him some form of
financial independence. But since the investment are few, the returns are only used to cover his
expenses. He often goes on holiday once a year but this year he did not make due to the altered
mobility.
The patient noted that he has been experiencing blurred vision, numbness in the face as
well as an electric shock type of feeling whenever he tries to move his head and neck. This shock
usually travels down the back up to his legs and this negatively impacts his movements as well
as gait. It is this shock however that makes it difficult for him to accomplish tasks such as
cooking, showering and dressing very difficult. Bending down to do up the shoe laces is also
difficult for him. Recently Mr.Dinh has started experiencing urinary incontinences. Dinh feels
that the condition is getting worse and he has started getting worried with uncertainty of his
future. The current medications include Panadol osteo 6/24 oral prn a maximum of 6 per day.
There is also the Teriflunomide 14mg which is administered orally on a daily basis. Finally,
there is prednisolone 25 mg that is also administered orally BD whenever there is an
exacerbation.

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CUES/INFORMATION
Some of the important cues or information from the case study include urine
incontinence. Mr. .Dinh reported recent urine incontinence .The patient also noted of blurred
vision and numbness in the face. He also feels an electric shock kind of feeling whenever he tries
to move his head and neck. The patient was also diagnosed with Multiple Sclerosis four years
ago. There are also cases of exacerbations since the patient noted that the situation has begun to
get worse.
PROCESSING OF INFORMATION
From the case study, it was established that the patient had urinary incontinence. Urinary
incontinence is typical of the patients who are suffering from multiple sclerosis. Fatigue and
altered mobility are also common signs and symptoms. This is due to the electric shock kind of
feeling that starts at the head and the neck whenever the patient tries to move and it moves at the
back up to the legs and this renders the patient immobile therefore needing moving aids such as
wheelchairs.
IDENTIFICATION OF THE PROBLEM
From the case study, there are several health problems that can be identified. One of the
problems is impaired Urinary elimination .This is because Mr. Dinh mentioned in the assessment
that he had started experiencing urine incontinence. According to the Millers functional
consequences theory, ageing has the potential to affect the functioning of some parts of the
body(Bramble, 2012). For urine incontinence, the likely reason might be inelastic muscles in the
bladder that makes it impossible to eliminate urine. Self-care deficit is another problem identified
from the case study. The patient describe a form of electric shock that travels form the head and

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the neck through the back to his legs (Jangi et al., 2016). This form of shock makes it difficult for
the patient to bend and carry out simple activities like showering, cooking as well as tying up his
shoe laces. Another problem that was identified in the case study was the risk for Care giver role
strain (Rocca et al., 2015). This is because the patient mentioned that he has a brother who is
called Bao but he doesn’t want to involve them since he feels he would be bothering them.
Fatigue is the final health problem identified in the case study. Mr. Dinh has been going on
holiday once a year but this is now impossible due to fatigue that arise as a result of altered
mobility.
ESTABLISHED GOALS
Based on the established health problems, there are different goals that are set to be
achieved during the nursing intervention. For the problem of fatigue, the identified or established
goals include identifying alternative that can help the patient maintain a desired level of activity
(Rotstein, Healy, Malik, Chitnis, & Weiner, 2015). Another goal is to identify potential risk
factors and the individual actions that can affect fatigue .Finally, the patient is also to participate
in the recommended treatment plan and report an improved sense of energy(Murrell, 2012) .For
urinary incontinence ,the established goals include free urine leakage and ability to completely
empty the bladder completely.
ACTION
For fatigue or altered mobility, the nursing interventions include noting down and
accepting the presence of fatigue. According to studies, fatigue is the most common symptom
among patients suffering from Multiple Sclerosis (Ransohoff, Hafler, & Lucchinetti, 2015). This
is because they spend very little energy which has a disproportionate impact on the ADLs and

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has a very slow recovery rate (Browne et al., 2014). The nurse should also identify and review
any factors that affect ability of the patient to be active such as temperature extremes, inadequate
food intake, insomnia, medications and finally the time of the day. The rationale for this
intervention is to offer an opportunity to improve on the mobility of the patient.
The nurse should accept whatever the patient cannot do and he or she should also
determine the need for walking aids, providing braces, walkers or even the wheelchairs. The
nurse is also supposed to review the different safety considerations(Belbasis, Bellou, Evangelou,
Ioannidis, & Tzoulaki, 2015) .The rationale for the mobility aids is to decrease fatigue while
enhancing independence as well as comfort and safety. The only set back with this type of
intervention is that the patient might develop a poor judgement on the ability to safely engage in
different activities (Veroni, Serafini, Rosicarelli, Fagnani, & Aloisi, 2018). Concerning accepting
whatever the physical activity the patient cannot accomplish, the nonjudgmental acceptance of
the patient’s evaluation offers an opportunity to promote independence of the patient while at the
same time assisting fluctuations in the level of the care needed.
The nurse is supposed to schedule ADLs early in the morning in case they are appropriate
and planning for consistent periods of rests as well as afternoon naps. The nurse is also supposed
to provide physical therapy and boost the patients comfort by massaging them and placing them
in relaxing baths (Thompson et al., 2018). The rationale for all these is just reduce the level of
fatigue and the aggravation of different muscles weaknesses.
Finally, the nurse should administer prednisone which as a steroid as prescribed. The
rationale for this medication is to reduce the development of edema as well as the sclerotic
plaques (Filippi et al., 2016).It should however be noted that long term treatment with the drug
has very little effect on how the symptoms progress.

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For urine incontinence, the nurse is supposed to review the drug regimen and then
institute bladder training as appropriate. The patient should also be encouraged to take enough
fluids and note the urinary frequency, nocturia and palpating of the bladder after each session of
voiding (Banwell & Yeshokumar, 2017). The rationale for all this is just to provide information
about the possible interference in urine elimination and this assists in restoring adequate bladder
functioning. The patients should also be encouraged to be mobile frequently. The rationale is to
prevent the likelihood of developing Urinary Tract Infections (Mahad, Trapp, & Lassmann,
2015). Finally, the nurse should refer the patient to the urinary continence specialist and this is
just to ensure that the patients’ needs are met.
EVALUATION OF OUTCOMES
After the nursing interventions, Mr. Dinh is now able to completely empty his bladder.
The patient can also not develop edema as well as sclerotic plagues due to the treatment using
prednisone. This drug causes loss of excess fluids in the body (Giovannoni et al., 2015). The
patient is also able to move around freely due to the physical therapy provided by the nurse.
REFLECTION
I have really learnt a lot form this case study .I have gained a lot of knowledge regarding
Multiple Sclerosis. There are things that I would however do differently in the future. I have
realized that instead of focusing on ADLs alone ,resting periods are also important and I would
also prefer to utilize relaxing baths for the patient .The overall nursing experience for the
Multiple sclerosis has however been well and I am looking forward to handle such a scenario
again.

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CONCLUSION
The condition affects the patient’s mobility. Some of the common signs and symptoms of
MS include fatigue, blurred vision and numbness in the face. Urinary incontinence is also
common among patients of the condition. The established goals in MS include ability to
completely empty the bladder, improve on the physical mobility of the patient and reduce fatigue
among the patients. There are different nursing interventions for MS and they include
administering different medications such as prednisone to prevent exacerbation and edema. The
nurse should also note the urinary frequency and urgency and review the treatment regimen. The
patient should also be encouraged to take adequate fluids and promote continued mobility.

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