Multiple Sclerosis Nursing Care Plan & Management


  1. Multiple sclerosis is a chronic, progressive, non- contagious, degenerative disease of the CNS characterized by demyelinization of the neurons.
  2. Multiple sclerosis usually occurs between the ages of 20 and 40 and consists of periods of remissions and exacerbations.
  3. The causes are unknown, but the disease is thought to be a result of an autoimmune response or viral infection.
  4. Precipitating factors include pregnancy, fatigue, stress, infection, and trauma.
  5. Electroencephalogram findings are abnormal
  6. A lumbar puncture indicates increased gamma globulin, but the serum globulin level is normal.

The cause of MS is unknown. Some evidence suggests that an infective agent causes a predisposition to MS, although that agent has not been identified. Some evidence supports immunologic, environmental, or genetic factors as possible causes of the disease. The risk of developing MS is 15 times higher when the disease is present in the patient’s immediate family. Conditions such as pregnancy, infection, and trauma seem to precipitate the onset of MS or cause relapses

  1. Fatigue and weakness
  2. Ataxia and vertigo
  3. Tremors and spasticity of the lower extremities
  4. Parasthesias
  5. Blurred vision and diplopia
  6. Nystagmus
  7. Dysphasia
  8. Decreased perception to pain, touch, and temperature
  9. Bladder and bowel disturbances, including urgency, frequency, retention, and incontinence
  10. Abnormal reflexes, including hyperreflexia, absent reflexes, and a positive Babinski’s reflex
  11. Emotional changes such as apathy, euphoria, irritability, and depression
  12. Memory changes and confusion

Primary Nursing Diagnosis

  • Impaired physical mobility related to fatigue and weakness.
Diagnostic Evaluation
  • Cerebrospinal fluid (CSF) analysis reveals elevated protein level, increased white blood cells. Electrophoresis of CSF shows increased myelin basic protein and IgG bands.
  • Other Tests: No single test reliably diagnoses MS. Supporting tests include electroencephalography, evoked potential studies, computed tomography (CT) scan, and magnetic resonance imaging (MRI).
Medical Management
  • Most medical treatment is designed to slow disease progression and address the symptoms of the disease, such as urinary retention, spasticity, and motor and speech deficits. Currently, however, physicians generally prescribe steroid therapy to reduce tissue edema during an acute exacerbation.
  • Consult with a physical therapist if the patient needs to learn how to use assistive devices or needs to learn exercises to maintain muscle tone and joint mobility.
  • Muscle stretching for spastic muscles and selective strengthening exercises for weakness are prescribed.
  • A social service agency may be required to help the family deal with the often expensive and long-term financial effect of the disease. Vocational redirection may also be required.
  • For a patient who is experiencing depression, consider a referral to a psychiatric clinical nurse specialist. Family counseling is often very helpful.
Pharmacologic Highlights
  • Corticosteroids agents, such as Prednisone (Orasone); methylprednisolone or (Solu-Medrol); dexamethasone(Decadron) maybe used to help decrease symptoms and induce remissions through anti-inflammatory effects.
  • Immunomodulatory agents, such as Interferon, cyclosporine, azathioprine, methotrexate maybe used to help decrease symptoms and induce remissions; treatment includes combination therapy using two or more of these agents.
  • Other Drugs: Antianxiety agents, such as chlordiazepoxide hydrochloride (Librium), may be prescribed to manage mood swings; baclofen (Lioresal) or dantrolene (Dantrium) may be used to relieve muscle spasticity; and patients with urinary symptoms may require behanechol (Urecholine) or oxybutynin (Ditropan).
Nursing Interventions
  1. Provide bed rest during exacerbation.
  2. Protect the client from injury by providing safety measures.
  3. Place an eye patch on the eye for diplopia.
  4. Monitor for potential complications such as urinary tract infections, calculuses, decubitus ulcers, respiratory tract infections, and contractures.
  5. Promote regular elimination by bladder and bowel training.
  6. Encourage independence.
  7. Assist the client to establish a regular exercise and rest program.
  8. Instruct the client to balance moderate activity with rest periods.
  9. Assess the need for and provide assistive devices.
  10. Initiate physical and speech therapy.
  11. Instruct the client to avoid fatigue, stress, infection, overheating, and chilling.
  12. Instruct the client to increase fluid intake and eat a balanced diet, including low-fat, high-fiber foods and foods high in potassium.
  13. Instruct the client in safety measures related to sensory loss, such as regulating the temperature of bath water and avoiding heating pads.
  14. Instruct the client in safety measures related to motor loss, such as avoiding the use of scatter rugs and using assistive devices.
  15. Instruct the client in the self-administration of prescribed medications.
  16. Provide information about the National Multiple Sclerosis Society.
Documentation Guidelines
  • Physical findings; Muscle strength, gait, muscle symmetry, visual response
  • Response to medications, treatments, and special therapies
  • Ability to perform self-care, bowel and bladder care
  • Presence of complications, infections, contractures
Discharge and Home Healthcare Guidelines
  • Be sure the patient understands any pain medication prescribed, including dosage, route, action, and side effects.
  • Be sure the patient understands the need for adequate bladder and bowel elimination.
  • Instruct the patient to notify the primary caregiver of any exacerbation or sudden worsening of the condition.
  • If the patient has difficulty speaking or communicating, be sure that she or he has access to a telephone support network or some other means of calling for assistance when she or he is at home alone for any length of time.
  • Be sure the patient understands that stress, fatigue, and being overheated stimulate exacerbations. Teach the patient how to avoid situations that produce these reactions. Be sure the patient knows how to contact community agencies such as the MS Society for use of such in-home equipment as beds and wheelchairs and home maintenance support.
  • Determine whether a home care agency is needed to provide home supervision and ongoing physical therapy support.



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Nursing Care Plan

Nursing Diganosis


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.