Multiple Sclerosis and Nursing Care
Published: 13 August 2020
Published: 13 August 2020
Multiple Sclerosis (MS) is a progressive neurological condition that causes an abnormal response from the immune system against the central nervous system. The myelin (the covering of the nerve fibres) and the nerve fibres themselves are attacked by the immune system, resulting in inflammation and formation of scar tissue (sclerosis). The nerve impulses that need to travel through these damaged nerve fibres are disrupted, causing a variety of neurological symptoms (Pietrangelo 2020).
The cause of MS remains unknown but it is thought to involve genetic, environmental and lifestyle factors. There is no single test for diagnosing MS, with methods often relying on the elimination of other causes first (Better Health Channel 2019).
Because the symptoms of MS vary between individuals, there needs to be evidence of at least two areas of damage in the central nervous system occurring at different times for a diagnosis of MS to be made (MSRA 2019).
MS is a progressive and unpredictable disease. Effects in some patients can be marginal, whilst others have a quick progression towards disability (MS Australia 2015). There are three main types of MS:
(MS QLD 2019; MS Australia 2015)
The symptoms of MS vary between individuals and are often unpredictable, with no two cases the same. Generally, symptoms depend on the area of the central nervous system that has been affected (MS Australia 2015).
One of the most common symptoms of MS is fatigue, which occurs in up to 90 per cent of patients and can significantly affect their quality of life (MSRA 2019).
MS can also cause difficulties with motor control, leading to muscle spasms, muscle weakness and problems with coordination, balance and limb functions. As MS affects the central nervous system, patients can also experience other neurological symptoms such as vertigo, pins and needles, neuralgia and visual disturbances (Better Health Channel 2019).
At least 80% of people with MS experience bladder dysfunction and some patients experience bowel issues such as incontinence and constipation (MS 2020).
People with MS can also experience neuropsychological symptoms such as memory loss, depression and cognitive difficulties (Better Health Channel 2019).
Other symptoms including heat sensitivity, sexual difficulties, pain, vision problems, spasticity, speech problems, swallowing problems, tremors, breathing problems, pruritus, headaches and hearing loss (Better Health Channel 2019; MS QLD 2019).
MS is multifaceted in nature so it is important that the mode of treatment reflects this. Patients often benefit from a multidisciplinary rehabilitation program.
The main goal of treatment is to maximise the quality of life by managing specific symptoms, shortening any exacerbations and slowing the progression of the disease. Rehabilitation can help prevent complications and secondary disabilities from developing, whilst also increasing patient safety, and is an integral part of improving the patient’s quality of life (Burks, Bigley & Hill 2009).
Treatments that can help to manage and relieve symptoms include:
(MS QLD 2017)
The prevalence of suicide, depression and other mental health disorders such as anxiety and bipolar disorder is higher in people with MS than the general population (Minden 2013). These conditions can be addressed within a rehabilitation program by a neuropsychologist and psychiatrist if necessary. Neuropsychologists can also assist with any memory or cognitive difficulties present in the individual.
A combination of physiotherapy and certain medication can help ease muscle spasms, tremors and stiffness. Fatigue can be managed by sleep regulation and also by medications which treat narcolepsy (MS 2020). Occupational therapists can also assist by helping patients learn energy-saving skills (which may involve the use of aids) and coping strategies to manage fatigue.
Other alternative therapies which may be used include acupuncture, chiropractic, massage, meditation, yoga and use of supplements.
The nurse plays an integral role in providing ongoing support to the patient whilst also participating in the prevention and management of symptoms (MacLean 2004). Nurses can help provide information, support and advice to the patient during their disease progression.
Nurses can assist with fatigue management by reinforcing any pacing and energy conservation techniques learned from the occupational therapist. They can ensure any mobility equipment is readily available and that the patient understands how to use it correctly. They can also assist by controlling factors which may be interfering with sleep (such as urinary problems).
Nurses can assist in the management of bowel and bladder dysfunction. This may involve the use of a toileting regime, education on continence management techniques and even teaching patients to self-catheterise.
The unpredictable nature of multiple sclerosis and a lack of strong diagnosis methods poses a multitude of challenges for medical professionals.
Therefore, it is imperative that when nursing these patients we adopt a multidisciplinary and individualised approach to achieve the highest level of patient care.
Question 1 of 3
True or false? Secondary-progressive MS begins as relapsing-remitting MS.
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Sally Moyle is a rehabilitation nurse educator who has completed her masters of nursing (clinical nursing and teaching). She is passionate about education in nursing so that we can become the best nurses possible. Sally has experience in many nursing sectors including rehabilitation, medical, orthopaedic, neurosurgical, day surgery, emergency, aged care, and general surgery. See Educator Profile