NCP Multiple Scelorsis

Multiple sclerosis (MS) is the most common of the demyelinating disorders and the predominant CNS disease among young adults. It is a chronic disorder in which irregular demyelination of the CNS (brain and spinal cord) results in emotional changes and varying degree of cognitive, motor, and sensory dysfunction at the central and peripheral level.

It is a perivascular inflammatory response, possibly to chronic viral infection in genetically susceptible individuals, producing a limited disruption in the blood-brain barrier, allowing [beta]-lymphocyte clones to colonize the CNS.

Research suggests that in addition to destruction of myelin sheaths (which facilitate the movement of nerve impulses), some underlying nerve fibers are also damaged or severed, which may account for the permanent neurological impairment.

MS is grouped into the following four types:

Relapsing-remitting: Periods of neurological dysfunction followed by partial or full recovery.

Primary-progressive: Steady decline with periods of minimal recovery (fairly uncommon).

Secondary-progressive: Initial pattern of relapse and recovery, which becomes steadily progressive over time.

Progressive-relapsing: Progressive from onset with clear exacerbations (rare).

MS is characterized by periods of exacerabations and remissions and is progressive in approximately 60% of patients.

Individual prognosis is variable and unpredictable, presenting complex physical, psychosocial, and rehabilitative issues.


Community or long-term care with intermittent hospitalization for disease-related complications.


Extended care

Pneumonia: microbial

Psychosocial aspects of care


Patient Assessment Database

Degree of symptomatology depends on the stage and extent of disease, areas of neuronal involvement.


May report: Extreme fatigue/weakness, exaggerated intolerance to activity, needing to rest after even simple activities such as shaving/showering; increased weakness/intolerance to temperature extremes, especially heat (e.g., summer weather, hot tubs)

Limitation in usual activities, employment, hobbies

Numbness, tingling in the extremities

Sleep disturbances, may awaken early or frequently for multiple reasons (e.g., nocturia, nocturnal spasticity, pain, worry, depression)

May exhibit: Absence of predictable pattern of symptoms

Generalized weakness, decreased muscle tone/mass (disuse), spasticity, tremors

Staggering, dragging of feet, ataxia

Intention tremors, decreased fine motor skills


May report: Dependent edema (steroid therapy or inactivity)

May exhibit: Blue/mottled, puffy extremities (inactivity)

Capillary fragility (especially on face)


May report: Statements of reflecting loss of self-esteem/body image

Expressions of grief

Anxiety/fear of exacerbations/progression of symptoms, pain, disability, rejection, pity

Keeping illness confidential

Feelings of helplessness, hopelessness, powerlessness (loss of control)

Personal tragedies (divorce, abandonment by SO/friends)

May exhibit: Denial, rejection

Mood changes, irritability, restlessness, lethargy, euphoria, depression, anger


May report: Nocturia

Incomplete bladder emptying, retention with overflow

Urinary/bowel hesitancy or urgency, incontinence of varying severity

Irregular bowel habits, constipation

Recurrent UTIs

May exhibit: Loss of sphincter control

Kidney stone formation, kidney damage


May report: Difficulty chewing, swallowing (weak throat muscles), sense of food sticking in throat, coughing after swallowing

Problems getting food to mouth (related to intentional tremors of upper extremities)

Hiccups, possibly lasting extended periods

May exhibit: Difficulty feeding self

Weight loss

Decreased bowel sounds (slowed peristalsis)

Abdominal bloating


May report: Difficulty with/dependence in some/all ADLs

Use of assistive devices/individual caregiver

May exhibit: Poor personal habits, disheveled appearance, signs of incontinence


May report: Weakness, nonsymmetrical paralysis of muscles (may affect one, two, or three limbs, usually worse in lower extremities or may be unilateral), numbness, tingling (prickling sensations in parts of the body)

Change in visual acuity (diplopia), scotomas (holes in vision), eye pain (optic neuritis)

Moving head back and forth while watching television, difficulty driving (distorted visual

field), blurred vision (difficulty focusing)

Cognitive changes, i.e., attention, comprehension, use of speech, problem solving, difficulty retrieving/recalling, sorting out information (cerebral involvement)

Difficulty making decisions

Communication difficulties, such as coining words


May exhibit: Mental status: Mood swings, depression, euphoria, irritability, apathy; lack of judgment; impairment of short-term memory; disorientation/confusion.

Scanning speech, slow hesitant speech, poor articulation

Partial/total loss of vision in one eye; vision disturbances

Positional/vibratory sense impaired or absent

Impaired touch/pain sensation

Facial/trigeminal nerve involvement, nystagmus, diplopia (brainstem involvement)

Loss of motor skills (major/fine), changes in muscle tone, spastic paresis/total immobility (advanced stages)

Ataxia, decreased coordination, tremors (may be originally misinterpreted as intoxication), intention tremor

Hyperreflexia, positive Babinski’s sign, ankle clonus; absent superficial reflexes (especially abdominal)


May report: Painful spasms, burning pain along nerve path (some patients do not experience normal pain sensations)

Frequency varied may be sporadic/intermittent (possibly once a day) or may be constant

Duration lightning-like, repetitive, intermittent; persistent long-term painful spasms of extremity or back

Facial neuralgia

Dull back pain

May exhibit: Distraction behaviors (restlessness, moaning), guarding



May report: Uneasiness around small children or moving objects, fear of falling (weakness, decreased vision, slowed reflexes, loss of position sense, decreased judgment)

History of falls/accidental injuries

Use of ambulation devices

Vision impairment

Suicidal ideation

May exhibit: Wall/furniture walking


May report: Relationship stresses

Enhanced or decreased sexual desire

Problems with positioning

Genital anesthesia/hyperesthesia, decreased lubrication (female)

Impotence/nocturnal erections or ejaculatory difficulties

Disturbances in sexual functioning (affected by nerve impairment, fatigue, bowel and bladder control, sense of vulnerability, and effects of medications)


May report: Lack of social activities/involvement

Withdrawal from interactions with others/isolation behaviors (e.g., stays at home/in room, watches TV all day)

Feelings of isolation (increased divorce rate/loss of friends)

Difficult time with employment because of excessive fatigue/cognitive dysfunction, physical limitations

May exhibit: Speech impairment


May report: Use of prescription/OTC medications, may forget to take regularly

Difficulty retaining information

Family history of disease (possibly due to common environmental/inherited factors)

Use of “holistic”/natural products/healthcare practices, “trying out cures,” “doctor shopping”

Discharge plan

DRG projected mean length of inpatient stay: 5.7 days.

May require assistance in any or all areas, depending on individual situation

May eventually need total care/placement in assisted living/extended care facility

Refer to section at end of plan for postdischarge considerations.


Brain MRI: Detects presence of plaques characteristic of MS that are due to nerve sheath demyelination, but is not diagnostic without supporting clinical symptoms.

CT scan: Demonstrates brain lesions, ventricular enlargement or thinning.

Evoked potentials: Visual (VER), brainstem auditory (BAER), and somatosensory (SSER) are abnormal early in a high percentage of patients with definite or suspected MS.

Lumbar puncture: CSF may show elevated levels of IgG and IgM. Protein level normal or only slightly elevated, oligoclonal bands present on electrophoresis; WBC count slightly elevated; elevated concentration of myelin basic protein may be noted during active demyelination process.

EEG: May be mildly abnormal in some cases.


1. Maintain optimal functioning.
2. Assist with/provide for maintenance of ADLs.
3. Support acceptance of changes in body image/self-esteem and role performance.
4. Provide information about disease process/prognosis, therapeutic needs, and available resources


1. Remain active within limits of individual situation.
2. ADLs are managed by patient/caregivers.
3. Changes in self-concept as acknowledged and being dealt with.
4. Disease process/prognosis, therapeutic regimen are understood and resources identified.
5. Plan in place to meet needs after discharge.