Jan 9, 2020 in Nursing

Multiple Sclerosis Nursing Care Plan

Introduction

Multiple Sclerosis (MS) is one of the most common neurological disorders among young adults within their 20s and 30s and one of the biggest challenges for public health officials in the United States (NMSS, 2010). Affected individuals tend to exhibit neurological abnormalities, including sensory disturbances as well as complete or partial paralysis, while the illness varies from relapsing/remitting to a chronic progressive course. Given that MS afflicts young people with near average life expectancy and has no effective prevention and treatment plan, the cost of the required health care, including the loss of productivity and patient rehabilitation, represents a socioeconomic burden to the society. It is in such effort that this paper presents a plan for health promotion and MS prevention in a 21-year old male patient in line with the Healthy People 2020 program. The patient was admitted in the emergency room complaining of blurred visions, loss of balance, feeling weakness in the legs and arms, and tingling. The patient also appeared to exihibit clumsiness, problems in thinking and numbness. A neurological examination together with a magnetic resonance imaging (MRI) scan affirmed that the patient had MS. Hence, a treatment plan is developed for the patient.

 

Purpose

The purpose of this treatment plan is to promote evidence-based nursing care to help prevent the development of multiple sclerosis in the patient. The plan applies to physically challenged 21-year-old males. The plan also aims to address health disparities, standardize care and be accessible to all care providers by:

  • Preventing the development of MS.
  • Implement specialized treatment plans to manage existing MS effectively.
  • Supporting families and healthcare professional with a framework for prevention nd and management of MS.

Background and Definition

MS is one of the prevalent disabling neurological conditions among young adults. It can be developed at any age, but most individuals are diagnosed between the age of 20 and 40 (Pietrangelo & Higuera, 2015). More than 400,000 people in the U.S. and approximately 2.5 million individuals around the globe have MS (Pietrangelo & Higuera, 2015). Approximately 200 cases are diagnosed weekly in the United States. The ratio of males to females with MS is 1:2 (Pietrangelo & Higuera, 2015). MS causes considerable damage to the patients' CNS. Early diagnosis of MS and implementation of effective preventive strategies can prevent CNS damage or reduce the severity of the neurological damage. The reduction of MS developed under the framework will serve as a quality indicator.

Responsibilities and Authority

The National Multiple Sclerosis Society (NMSS)  will train all staff providing MS patient care to maintain their competence in MS prevention. Training will entail risk assessment, service delivery, neuro-rehabilitation, recording and reporting MS, neurological therapy, provision and use of equipment. Further, NMSS will ensure that all physically challenged 21 males receive necessary equipment as assessed. Discharging or transferring entity must ensure that adequate medication and equipment are provided by the receiving entity. Figure 1.  Is  a depiction of multidisciplinary MS Care (modified from International Organization of Multiple Sclerosis Nurses IOMSN)   

Figure 1

multidisciplinary MS Care

Priorities Areas

This plan is committed to achieving the health promotion and disease prevention objectives of Healthy People 2020, which in itself is a government-based activity for establishing priority areas. Consequently, the Multiple Sclerosis Nursing Care Plan is focused on the area of chronic disabling diseases. People with physical and mental disabilities have fewer health days, register a lower rate of health-promoting behaviors, including poor nutritional intake and physical inactivity. Thus, developing innovative strategies and nursing health plans that promote health among young males with physical and mental disabilities is taken as considered as the plan's priority.

Health professionals should also recognize that the health disparities between male MS patients with or without disabilities require much attention to establishing disability-friendly nursing care plans. Such plans should reduce programmatic and attitudinal barriers that make it difficult for patients to engage in effective health promotion practices. Moreover, empowering 21-year-old males with disabilities to self-manage their MS condition requires the support of community service providers in the advocacy of greater access to MS health promotion programs, venues, and services.

The Healthy People 2020

One of the goals of Healthy People 2020 is to advocate the health and well-being of people with special needs.. The disability and health objectives highlight the priority areas for improvement and opportunities for individuals with special needs to receive timely interventions and services, and be included in public health activities. Without these possibilities, a physically challenged MS patient would continue experiencing disparities with the general population. For this reason, the 2020 objectives cover various aspects of people from disability communities. 

The MS Nursing Care Plan 

a. Sectorial Interventions

The section below provides a sample of interventions that can be implemented by the sectors.

i. Health information technology should be unitized to facilitate more enrollment, risk assessment/screening, referral and care coordination practices across the health service providers.

ii. Providers should implement health practices to the expedite enlistment of low-income male MS patients in Medicaid.

iii. Public health professionals should work with peer counselors and community health workers to reinforce health education and the utilization of health care service among young males.

iv. Improve social support to high-risk 21-year-old male patients.

v. Develop educational messages that would demonstrate a positive impact on changes in skills, behaviors, attitudes and knowledge related to MS.

vi. Facilitate community-based participatory research to include the affected 21-year-old males in raising awareness of health disparities. 

vii. Additionally, the experts have to identify, develop and implement comprehensive solutions.

b. Evidence-Based Interventions

  1. Educational Training

When planning the appropriate educational interventions, several variables that may affect the patient’s learning should be taken into consideration. One of the key elements that should be prioritized in the patient’s treatment is the ways an individual learns, and the content is retained. Other variables that should be given priority include emotional readiness, physical readiness, values and illness states. A discussion and demonstration between the caregiver and the patients is also recommended for the physically challenged MS patients. Additionally, the demonstration and practice are key pillars of a teaching program, particularly when acquiring new skills, as nurses should demonstratea skill and then give the learners an opportunity to practice it. In scenarios where equipment is involved, the caregiver should train using the same equipment that will be used by the patient.

  1. Disease-modifying drugs. 

The most commonly utilized disease modifying drugs for MS are glatiramer acetate and beta-interferons (1a and 1b). An issue of note is that the high costs associated with them hinder the access for the majority of patients. The preferred medications for MS are the corticosteroids, which are used in the treatment of exacerbations and can be administered either in the hospital care or community settings. Besides the strategies that target at reducing the impact associated with MS, some drugs are specifically used to amend its common systems, such as neuropathic pain, spasticity, and urinal dysfunction. 

  1. Rehabilitation

Despite the fact that drug treatment options for MS are somewhat limited, substantial enhancements in the quality of life for individuals having MS can be enhanced through rehabilitation strategies. For instance, physical exercise and physiotherapy have been reported to be useful for patients with moderate disabilities. All in all, the aspects of MS evidence-based strategies in this plan include neuro-rehabilitation, service delivery, and enhancing the quality of life.

  • Neuro-rehabilitation

It places emphasis on patient self-management and education to address the complex needs associated with MS. Neuro-rehabilitation has the objective of enhancing independence as well as the quality of life through ensuring that patients maximize their ability as well as participation. The components of its effectiveness include multi-disciplinary evaluation of the patient, development of goal-oriented programs, and assessing the impact on goal achievement and individual results.

  • Service Delivery

Assessing the service delivery has been identified as the most crucial issue on managing MS. It stems from the fact that it utilizes the neuro-rehabilitation and acute hospital assistance in conjunction with community-based initiatives to ensure the execution of medical and social services in a manner that suits the complex needs of an individual having MS. Essentially, community-based assistance is preferred, when, in case of need, supported by experts from a rehabilitation. The optimal service delivery method for MS is yet to be developed despite the various forms that are already in use. One of such forms is a home hospital care, whereby patients are located in the community, even though they have an easy and instant access to a multidisciplinary hospital-based team. Studies have shown that no significant differences exist between routine care and hospital homecare in terms of disability level; although hospital homecare tends to result in significantly lower depression and improvements in the quality of life. Moreover, it is also important for the care delivery to be patient-centered and interdisciplinary, which entails incorporating other professionals such as social workers, clinical psychologists, language and speech therapists, occupational therapists, physiotherapists, nurses and doctors.

  • Quality of Life

MS significantly reduces an individual quality of life (QOL). Therefore, its enhancing should be a priority when developing a nursing care plan for MS. The QOL areas for MS patients include empowering their independence, continuing care, ensuring the support of members of the person’s family, helping them to get meaningful employment or be involved in volunteer activities, and ensuring accessibility in their environment.

Conclusion 

Health promotion is one of the highest ranked health concerns of the United States public. Accordingly, prevention is emphasized as one of the pillars of health advocacy because it bridges personal behavior and health. The program Healthy People 2020 outlines the present national health promotion and disease prevention in the United States. Hence, the key goals are to improve the quality of life and eliminate health disparities among various population groups. Current research evidence supports the cost-effectiveness of addressing MS health issues in the early years of their occurrence. The formulation of this plan should involve multiple stakeholders, including non-profit and for-profit entities, public or private, such as local government, hospital, colleges, universities, and laboratories. Moreover, further research is needed along the priority areas to investigate the comprehension of the causation, diagnosis, pathogenesis and effective treatment for this incapacitating disease.

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