Nursing care plans for multiple sclerosis with examples 1

Nursing Care Plans For Multiple Sclerosis Plus Interventions With Examples

Introduction

Multiple sclerosis, or MS, is a long-lasting disease that can affect the brain, spinal cord, and optic nerves in the eyes. It can cause problems with vision, balance, muscle control, and other essential body functions.

The effects are often different for everyone who has the disease. Some people have mild symptoms and don’t need treatment. Others will have trouble getting around and doing daily tasks.

MS happens when the immune system attacks a fatty material called myelin, which wraps around the nerve fibers to protect them. Without this outer shell, the nerves become damaged. Scar tissue may form.

The damage means the brain can’t send signals through the body correctly. The nerves also don’t work as they should to help one move and feel.

This blog post discusses about multiple sclerosis ; its symptoms, causes, nursing care plans and interventions with some examples .As you follow along, remember that our qualified writers are always ready to help in any of your nursing assignments. All you need to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Symptoms of Multiple Sclerosis

Nursing care plans for multiple sclerosis with examples 2
Nursing Care Plans For Multiple Sclerosis With Examples 8
  • Trouble walking
  • Feeling tired
  • Muscle weakness or spasms
  • Blurred or double vision
  • Numbness and tingling
  • Sexual problems
  • Poor bladder or bowel control
  • Pain
  • Depression
  • Problems focusing or remembering

The first symptoms often start between ages 20 and 40. Most people with MS have attacks, also called relapses, when in noticeably worse conditions. They’re usually followed by times of recovery when symptoms improve. For other people, the disease continues to get worse over time.

Scientists have found many new treatments that can often help prevent relapses and slow the disease’s effects in recent years.

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Nursing care plans for multiple sclerosis with examples 3

Causes of Multiple Sclerosis

Doctors don’t know for sure what causes MS, but many things seem to make the disease more likely. People with certain genes may have higher chances of getting it. Smoking also may raise the risk.

Some people may get MS after they’ve had a viral infection — like the Epstein-Barr virus or the human herpesvirus 6 — that makes their immune system stop working normally. The infection may trigger the disease or cause relapses. Scientists are studying the link between viruses and MS, but they don’t have a clear answer yet.

Some studies suggest that vitamin D, which you can get from sunlight, may strengthen your immune system and protect you from MS. Some people with higher chances of getting the disease who move to sunnier regions seem to lower their risk.

Diagnosis of Multiple Sclerosis

It can be hard to diagnose MS since its symptoms can be the same as many other nerve disorders. If a doctor thinks a patient has it, they’ll want them to see a specialist who treats the brain and nervous system, called a neurologist. They’ll ask about medical history and check for key signs of nerve damage in the brain, spinal cord, and optic nerves.

There’s no single test that can prove that one has MS. A doctor will use a few different ones to diagnose it. These may include:

  1. Blood tests to rule out diseases that cause similar symptoms, like Lyme disease and AIDS.
  2. Checks of balance, coordination, vision, and other functions to see how well the nerves are working.
  3. A test that makes detailed pictures of the structures in the body is called an MRI.
  4. Analysis of the liquid that cushions the brain and spinal cord called cerebrospinal fluid (CSF). People with MS usually have specific proteins in their CSF.
  5. Tests (called evoked potentials) measure the brain’s electrical activity.
  6. OCT (Optical coherence tomography) is used to detect changes in the retina which could warn of brain atrophy

Treatment of Multiple Sclerosis

There is no cure for MS right now, but a number of treatments can improve how you feel and keep the body working well.

A doctor can prescribe drugs that may slow the course of the disease, prevent or treat attacks, ease the symptoms, or help manage the stress that can come with the condition.

Drugs that may slow your MS or help nerve damage include:

Beta interferon (Avonex, Betaseron, and Rebif)

  • Cladribrine (Mavenclad)
  • Dalfampridine (Ampyra)
  • Dimethyl fumarate (Tecfidera)
  • Glatiramer (Copaxone)
  • Mitoxantrone (Novantrone)
  • Natalizumab (Tysabri)
  • Ocrelizumab (Ocrevus)
  • Ozanimod (Zeposia)
  • Siponimod (Mayzent)
  • Teriflunomide (Aubagio)

A doctor may give steroids to make MS attacks shorter and less severe. A patient can also try other drugs, like muscle relaxants, tranquilizers, or botulinum toxin (Botox), to ease muscle spasms and treat some of the other symptoms.

A physical therapist can teach exercises that will keep up the strength and balance and help a patient manage fatigue and pain. An occupational therapist can teach a patient a new way to do certain tasks to make it easier to work and take care of themselves. If a patient has trouble getting around, a cane, walker, or braces can help them walk more easily.

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Nursing care plans for multiple sclerosis with examples 3

Nursing Care Plans for Multiple Sclerosis Based on Nursing Diagnosis

Nursing Care Plan 1 – Fatigue

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 a recommended treatment program.
  • Report improved sense of energy.

Nursing Interventions

Note and accept the presence of fatigue.

Rationale: Fatigue is the most persistent and common symptom of MS. Studies indicate that the fatigue encountered by patients with MS occurs with an expenditure of minimal energy, is more frequent and severe than “normal” fatigue, has a disproportionate impact on ADLs, has a slower recovery time, and may show no direct relationship between fatigue severity and patient’s clinical neurological status.

Identify and review factors affecting the ability to be active: temperature extremes, inadequate food intake, insomnia, use of medications, time of day.

Rationale: Provides an opportunity to problem-solve to maintain or improve mobility.

Accept when a patient is unable to do activities.

Rationale: Ability can vary from moment to moment. Nonjudgmental acceptance of patients’ evaluation of day-to-day variations in capabilities provides an opportunity to promote independence while supporting fluctuations in the level of required care.

Determine the need for walking aids. Provide braces, walkers, or wheelchairs. Review safety considerations.

Rationale: Mobility aids can decrease fatigue, enhancing independence and comfort, as well as safety. However, individuals may display poor judgment about their ability to engage in inactivity safely.

Schedule ADLs in the morning if appropriate. Investigate the use of a cooling vest.

Rationale: Fatigue commonly worsens in the late afternoon (when body temperature rises). Some patients report lessening of fatigue with stabilization of body temperature.

Plan care consistent rest periods between activities. Encourage afternoon nap.

Rationale: Reduces fatigue aggravation of muscle weakness.

Assist with physical therapy. Increase patient comfort with massages and relaxing baths.

Rationale: Reduces fatigue and promotes a sense of wellness.

Stress needs for stopping exercise or activity just short of fatigue.

Rationale: Pushing self beyond individual physical limits can result in excessive or prolonged fatigue and discouragement. In time, a patient can become very adept at knowing limitations.

Investigate the appropriateness of obtaining a service dog.

Rationale: Service dogs can increase patients’ level of independence. They can also assist in energy conservation by carrying items in “saddle” bags and retrieving or performing tasks.

Recommend participation in groups involved in fitness or exercise and/or the Multiple Sclerosis Society.

Rationale: Can help a patient to stay motivated to remain active within the limits of the disability or condition. Group activities need to be selected carefully to meet patients’ needs and prevent discouragement or anxiety.

Administer medications as indicated:

Amantadine (Symmetrel); pemoline (Cylert)

Rationale: Useful in the treatment of fatigue. Positive antiviral drug effect in 30%–50% of patients. Use may be limited by side effects of increased spasticity, insomnia, paresthesias of hands and feet.

Methylphenidate (Ritalin), modafinil (Provigil)

Rationale: CNS stimulants that may reduce fatigue but may also cause side effects of nervousness, restlessness, and insomnia.

Sertraline (Zoloft), fluoxetine (Prozac)

Rationale: Antidepressants useful in lifting mood and “energizing” patients (especially when depression is a factor) and when the patient is free of anticholinergic side effects.

Tricyclic antidepressants: amitriptyline (Elavil), nortriptyline (Pamelor)

Rationale: Useful in treating emotional lability, neurogenic pain, and associated sleep disorders to enhance willingness to be more active.

Anticonvulsants: carbamazepine (Tegretol), gabapentin (Neurontin), lamotrigine (Lamictal)

Rationale: Used to treat neurogenic pain and sudden, intermittent spasms related to spinal cord irritation.

Steroids: prednisone (Deltasone), dexamethasone (Decadron), methylprednisolone (Solu-Medrol)

Rationale: May be used during acute exacerbations to reduce and prevent edema formation at the sclerotic plaques. Note: Long-term therapy seems to have little effect on the progression of symptoms.

Vitamin B

Rationale: Supports nerve-cell replication, enhances metabolic functions, and may increase a sense of well-being and energy level.

Immuno-modulating agents: cyclo phosphamide (Cytoxan), azathioprine (Imuran), methotrexate (Mexate), interferon [beta]-1B (Betaseron); interferon [beta]-1A (Avonex, Rebif), glatiramer (Copaxone); mitoxantrone (Novantrone).

Rationale: May be used to treat acute relapses, reduce the frequency of relapse, and promote remission. Interferon [beta]-1B (Betaseron) has been approved for use by ambulatory patients with remitting relapsing MS and is the first drug found to alter the course of the disease. Current research indicates early treatment with drugs that reduce inflammation and lesion formation may limit permanent damage. Therapy of choice is “A, B, C” drugs: Avonex, Betaseron, and Copaxone. Therapeutic benefits have been reported in patients at all stages of disability with a reduction in both steroid use and hospital days. (Copaxone chemically resembles a component of myelin and may act as a decoy, diverting immune cells away from myelin target.) Note: Novantrone may be used if other medications are not effective but are contraindicated in patients with primary progressive MS.

Prepare for plasma exchange treatment as indicated.

Rationale: Research suggests that individuals experiencing severe exacerbations not responding to standard therapy may benefit from a course of plasma exchange

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Nursing care plans for multiple sclerosis with examples 3

Nursing Care Plan 2- Self-care Deficit

May be related to:

  • Neuromuscular/perceptual impairment; intolerance to activity; decreased strength and endurance; motor impairment, tremors
  • Pain, discomfort, fatigue
  • Memory loss
  • Depression

Possibly evidenced by frustration, inability to perform tasks of self-care, poor personal hygiene.

Desired Outcomes

  • Identify individual areas of weakness/needs.
  • Demonstrate techniques/lifestyle changes to meet self-care needs.
  • Perform self-care activities within a level of own ability.
  • Identify personal/community resources that provide assistance.

Nursing Interventions

Determine current activity level and physical condition. Assess the degree of functional impairment using a 0–4 scale.

Rationale: Provides information to develop a plan of care for rehabilitation. Note: Motor symptoms are less likely to improve than sensory ones.

Encourage the patient to perform self-care to the maximum of ability as defined by the patient. Do not rush patients.

Rationale: Promotes independence and sense of control; may decrease feelings of helplessness.

Assist according to the degree of disability; allow as much autonomy as possible.

Rationale: Participation in own care can ease the frustration over the loss of independence.

Encourage patient input in planning schedule.

Rationale: The patient’s quality of life is enhanced when desires and likes are considered in daily activities.

Note the presence of fatigue.

Rationale: Fatigue experienced by patients with MS can be very debilitating and greatly impact the ability to participate in ADLs. The subjective nature of reports of fatigue can be misinterpreted by healthcare providers and family, leading to conflict and the belief that the patient is “manipulative” when, in fact, this may not be the case.

Encourage scheduling activities early in the day or during the time when the energy level is best.

Rationale: Patients with MS expend a great deal of energy to complete ADLs, increasing the risk of fatigue, which often progresses through the day.

Allot sufficient time to perform tasks, and display patience when movements are slow.

Rationale: Decreased motor skills and spasticity may interfere with the ability to manage even simple activities.

Anticipate hygienic needs and calmly assist as necessary with the care of nails, skin, and hair; mouth care; shaving.

Rationale: Caregiver’s example can set a matter-of-fact tone for acceptance of handling mundane needs that may be embarrassing to the patient and repugnant to SO.

Provide assistive devices and aids as indicated: shower chair, elevated toilet seat with arm supports.

Rationale: Reduces fatigue, enhancing participation in self-care.

Reposition frequently when a patient is immobile (bed or chair bound). Provide skincare to pressure points, such as sacrum, ankles, and elbows. Position properly and encourage to sleep prone as tolerated.

Rationale: Reduces pressure on susceptible areas prevents skin breakdown. Minimizes flexor spasms at knees and hips.

Provide massage and active or passive ROM exercises on a regular schedule. Encourage the use of splints or footboards as indicated.

Rationale: Prevents problems associated with muscle dysfunction and disuse. It helps maintain muscle tone strength and joint mobility and decreases the risk of loss of calcium from bones.

Encourage stretching and toning exercises and use of medications, cold packs, and splints, and maintenance of proper body alignment, when indicated.

Rationale: Helps decrease spasticity and its effects.

Problem-solve ways to meet nutritional and fluid needs.

Rationale: Provides for adequate intake and enhances patient’s feelings of independence or self-esteem.

Consult with physical and/or occupational therapist.

Rationale: Useful in identifying devices and/or equipment to relieve spastic muscles, improve motor functioning, prevent and reduce muscular atrophy and contractures, promote independence, and an increasing sense of self-worth.

Administer medications as indicated:

Tizanidine (Zanaflex), baclofen (Lioresal), carbamazepine (Tegretol);

Rationale: Newer drugs are used for reducing spasticity, promoting muscle relaxation, and inhibiting reflexes at the spinal nerve root level. Enhance mobility and maintenance of activity. Tizanidine (Zanaflex) may have an additive effect with baclofen (Lioresal) but use with caution because both drugs have similar side effects. The short duration of action requires careful individualizing of dosage to maximize therapeutic effect.

Diazepam (Valium), clonazepam (Klonopin), cyclobenzaprine (Flexeril), gabapentin (Neurontin, dantrolene (Dantrium);

Rationale: A variety of medications are used to reduce spasticity. The mechanisms are not well understood, and responses vary in each person. Therefore, it may take a period of medication trials to discover what provides the most effective relief of muscle spasticity and associated pain. Note: Adverse effects may be increased muscle weakness, loss of muscle tone, and liver toxicity.

Meclizine (Antivert), scopolamine patches (Transderm-Scop).

Rationale: Reduces dizziness, allowing a patient to be more mobile.

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Nursing care plans for multiple sclerosis with examples 3

Nursing Care Plan 3 –Risk for Caregiver Role Strain

Risk factors may include:

  • The severity of illness of the care receiver, duration of caregiving required,
  • Complexity/amount of caregiving task
  • Caregiver is female, spouse
  • Care receiver exhibits deviant, bizarre behavior
  • Family/caregiver isolation; lack of respite and recreation

Desired Outcomes

  • Identify individual risk factors and appropriate interventions.
  • Demonstrate/initiate behaviors or lifestyle changes to prevent the development of an impaired function.
  • Use available resources appropriately.
  • Report satisfaction with plan and support available.

Nursing Interventions

Note the physical/mental condition therapeutic regimen of the care receiver.

Rationale: Determines individual needs for planning care. Identifies strengths and how much responsibility the patient may be expected to assume, as well as disabilities requiring accommodation.

Determine caregiver’s level of commitment, responsibility, involvement in, and anticipated length of care. Use assessment tools, such as Burden Interview, to further determine caregiver’s abilities, when appropriate.

Rationale: Progressive debilitation taxes caregiver and may alter the ability to meet patient or own needs.

Discuss caregiver’s view of and about the situation.

Rationale: Allows ventilation and clarification of concerns, promoting understanding.

Determine available supports and resources currently used.

Rationale: Organizations can provide information regarding the adequacy of support and identify needs.

Facilitate family conferences to share information and develop a plan for involvement in care activities as appropriate.

Rationale: When others are involved in care, the risk of one person’s becoming overloaded is lessened.

Identify additional resources to include financial legal assistance.

Rationale: These areas of concern can add to the burden of caregiving if not adequately resolved.

Identify adaptive equipment needs and resources for the home and vehicles.

Rationale: Enhances independence and safety of both caregiver and patient.

Provide information and/or demonstrate techniques for dealing with acting-out or violent or disoriented behavior.

Rationale: Helps caregiver maintain a sense of control and competency. Enhances safety for care receiver and caregiver.

Stress importance of self-nurturing: pursuing self-development interests, personal needs, hobbies, and social activities.

Rationale: Taking time for self can lessen the risk of “burnout”/being overwhelmed by the situation.

Identify alternate care sources (such as sitter or daycare facility), senior care services, home care agencies.

Rationale: As the patient’s condition worsens, SO may need additional help from several sources to maintain the patient at home, even on a part-time basis.

Assist caregiver in planning for changes that may be necessary for the care receiver (eventual placement in an extended care facility).

Rationale: Planning for this eventually is important for the time when the burden of care becomes too great.

Refer to supportive services as need indicates.

Rationale: Medical case manager or social services consultant may be needed to develop an ongoing plan to meet changing needs of the patient and SO/family.

Nursing Care Plan 4 – Impaired Urinary Elimination

May be related to neuromuscular impairment (spinal cord lesions/neurogenic bladder).

Possibly evidenced by:

  • Incontinence; nocturia; frequency
  • Retention with overflow
  • Recurrent UTIs

Desired Outcomes

  • Verbalize understanding of the condition.
  • Demonstrate behaviors/techniques to prevent/minimize infection.
  • Empty bladder completely and regularly (voluntarily or by catheter as appropriate).
  • Be free of urine leakage.

Nursing Interventions

Note reports of urinary frequency, urgency, burning, incontinence, nocturia, and size or force of the urinary stream. Palpate bladder after voiding.

Rationale: Provides information about the degree of interference with elimination or may indicate a bladder infection. Fullness over the bladder following void is indicative of inadequate emptying or retention and requires intervention.

Review drug regimen, including prescribed, over-the-counter (OTC), and street.

Rationale: A number of medications such as some antispasmodics, antidepressants, and narcotic analgesics; OTC medications with anticholinergic or alpha agonist properties; or recreational drugs such as cannabis may interfere with bladder emptying.

Institute bladder training program or timed voidings as appropriate.

Rationale: Helps restore adequate bladder functioning; lessens the occurrence of incontinence and bladder infection.

Encourage adequate fluid intake, avoid caffeine and use of aspartame, and limit intake during late evening and at bedtime. Recommend use of cranberry juice/ vitamin C.

Rationale: Sufficient hydration promotes urinary output and aids in preventing infection. Note: When a patient is taking sulfa drugs, sufficient fluids are necessary to ensure adequate excretion of the drug, reducing the risk of cumulative effects. Note: Aspartame, a sugar substitute (e.g., Nutrasweet), may cause bladder irritation leading to bladder dysfunction.

Promote continued mobility.

Rationale: Decreases risk of developing UTI.

Recommend good hand washing and proper perineal care.

Rationale: Reduces skin irritation and risk of ascending infection.

Encourage the patient to observe for sediments or blood in urine, foul odor, fever, or unexplained increase in MS symptoms.

Rationale: Indicative of infection requiring further evaluation or treatment.

Refer to urinary continence specialist as indicated.

Rationale: Helpful for developing an individual plan of care to meet patient’s specific needs using the latest techniques continence products.

Administer medications as indicated:

Oxybutynin (Ditropan), propantheline (Pro-Banthine), hyoscyamine sulfate (Cytospaz-M), flavoxate hydrochloride (Urispas), tolterodine (Detrol).

Rationale: Reduce bladder spasticity and associated symptoms of frequency, urgency, incontinence, nocturia.

Catheterize as indicated.

Rationale: May be necessary as a treatment and for evaluation if a patient is unable to empty bladder or retains urine.

Teach self-catheterization and instruct in the use and care of indwelling catheters.

Rationale: Helps patient maintain autonomy and encourages self-care. An indwelling catheter may be required, depending on the patient’s abilities and degree of urinary problem.

Obtain periodic urinalysis and urine culture and sensitivity as indicated.

Rationale: Monitors renal status. A colony count over 100,000 indicates the presence of infection requiring treatment.

Administer anti-infective agents as necessary:

Nitrofurantoin macrocrystals. (Macrodantin); co-trimoxazole (Bactrim, Septra); ciprofloxacin (Cipro); norfloxacin (Noroxin).

Rationale: Bacteriostatic agents that inhibit bacterial growth and destroy susceptible bacteria. Prompt treatment of infection is necessary to prevent serious complications of sepsis/shock.

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Nursing care plans for multiple sclerosis with examples 3

Nursing Care Plan 5 -Powerlessness/Hopelessness

May be related to:

  • Illness-related regimen, the unpredictability of the disease
  • Lifestyle of helplessness

Possibly evidenced by:

  • Verbal expressions of having no control or influence over a situation
  • Depression over physical deterioration that occurs despite patient compliance with a regimen
  • Nonparticipation in care or decision making when opportunities are provided
  • Passivity, decreased verbalization/effect
  • Verbal cues
  • Lack of involvement in care/passively allowing care
  • Isolating behaviors/social withdrawal

Desired Outcomes

  • Identify and verbalize feelings.
  • Use coping mechanisms to counteract feelings of hopelessness.
  • Identify areas over which the individual has control.
  • Participate/monitor and control own self-care and ADLs within limits of the individual situation.

Nursing Interventions

Note behaviors indicative of powerlessness or hopelessness. A patient may say statements of despair.

Rationale: The degree to which a patient believes their own situation is hopeless, that he or she is powerless to change what is happening, affects how the patient handles life situations.

Acknowledge the reality of the situation, at the same time expressing hope for the patient.

Rationale: Although the prognosis may be discouraging, remissions may occur, and because the future cannot be predicted, hope for some quality of life should be encouraged. Additionally, research is ongoing, and new treatment options are being initiated.

Encourage and assist the patient in identifying activities he or she would like to be involved in within the limits of his or her abilities.

Rationale: Staying active and interacting with others counteract feelings of helplessness.

Discuss plans for the future. Suggest visiting alternative care facilities taking a look at the possibilities for care as condition changes.

Rationale: When options are considered and plans are made for any eventuality, the patient has a sense of control over their own circumstances.

Determine the degree of mastery the patient has exhibited in life to the present. Note locus of control.

Rationale: Patient who has assumed responsibility in life previously tends to do the same during difficult times of exacerbation of illness. However, if the locus of control has been focused outward, a patient may blame others and not take control over their own circumstances.

Assist patients in identifying factors that are under their own control. List things that can or cannot be controlled.

Rationale: Knowing and accepting what is beyond individual control can reduce helplessness, or acting out behaviors promote focusing on areas individuals can control.

Encourage the patient to assume control over as much of their own care as possible.

Rationale: Even when unable to do much physical care, an individual can help plan care, having a voice in what is desired or not.

Discuss needs openly with patient/SO, setting up agreed-on routines for meeting identified needs.

Rationale: Helps deal with manipulative behavior when a patient feels powerless and not listened to.

Incorporate patient’s daily routine into home care schedule or hospital stay, as possible.

Rationale: Maintains a sense of control and self-determination, and independence.

Refer to vocational rehabilitation as indicated.

Rationale: Can assist patient to develop and implement a vocational plan incorporating specific interests and/or abilities.

Identify community resources.

Rationale: Participation in structured activities can reduce the sense of isolation and may enhance the feeling of self-worth.

Nursing Care Plan 6 -Risk for Ineffective Coping

Risk factors may include:

  • Physiological changes (cerebral and spinal lesions)
  • Psychological conflicts; anxiety; fear
  • Impaired judgment, short-term memory loss; confusion; unrealistic perceptions/ expectations, emotional lability
  • Personal vulnerability; inadequate support systems
  • Multiple life changes
  • Inadequate coping methods

Desired Outcomes

  • Recognize the relationship between disease process (cerebral lesions) and emotional responses changes in thinking/behavior.
  • Verbalize awareness of own capabilities/strengths.
  • Display effective problem-solving skills.
  • Demonstrate behaviors/lifestyle changes to prevent/minimize changes in mentation and maintain reality orientation.

Nursing Interventions

Assess current functional capacity and limitations; note the presence of distorted thinking processes, labile emotions, cognitive dissonance. Note how these affect the individual’s coping abilities.

Rationale: Organic or psychological effects may cause the patient to be easily distracted, to display difficulties with concentration, problem-solving, dealing with what is happening, being responsible for their own care.

Determine the patient’s understanding of the current situation and previous methods of dealing with life’s problems.

Rationale: Provides a clue as to how a patient may deal with what is currently happening and helps identify individual resources and need for assistance.

Discuss the ability to make decisions, care for children or dependent adults, handle finances. Identify options available to individuals involved.

Rationale: Impaired judgment, confusion, inadequate support systems may interfere with the ability to meet own needs and the needs of others. Conservatorship, guardianship, or adult protective services may be required until (if ever) the patient is able to manage their own affairs.

Maintain an honest, reality-oriented relationship.

Rationale: Reduces confusion and minimizes painful, frustrating struggles associated with adaptation to an altered environment or lifestyle.

Encourage verbalization of feelings and/or fears, accepting what the patient says in a nonjudgmental manner. Note statements reflecting powerlessness, inability to cope.

Rationale: May diminish patient’s fear, establish trust, and provide an opportunity to identify problems and begin the problem-solving process.

Observe nonverbal communication: posture, eye contact, movements, gestures, and use of touch. Compare with verbal content and verify meaning with a patient as appropriate.

Rationale: May provide significant information about what the patient is feeling; however, verification is important to ensure accuracy of communication. The discrepancy between feelings and what is being said can interfere with the ability to cope, problem-solve.

Provide clues for orientation: calendars, clocks, notecards, organizers.

Rationale: These serve as tangible reminders to aid recognition and permeate memory gaps and enable patients to cope with the situation.

Encourage the patient to tape-record important information and listen to the recording periodically.

Rationale: Repetition puts information in long-term memory, where it is more easily retrieved and can support the decision-making and problem-solving process.

Refer to cognitive retraining program.

Rationale: Improving cognitive abilities can enhance basic thinking skills when attention span is short; ability to process information is impaired; the patient is unable to learn new tasks; or insight, judgment, and problem-solving skills are impaired.

Refer to counseling, psychiatric clinical nurse specialist, and/or psychiatrist, as indicated.

Rationale: May need additional help to resolve issues of self-esteem and regain effective coping skills.

Administer medications as appropriate: amitriptyline (Elavil); bupropion (Wellbutrin); imipramine (Tofranil);

Rationale: Medications to improve mood and restful sleep may be useful in combating depression and relieving the degree of fatigue interfering with function.

References