Activity 27.5: Critical thinking

If you were caring for a patient living with multiple sclerosis:

  • Consider what phase of their long term condition they may be experiencing?
  • Consider what the priorities of care may be at their stage of the illness?
  • How will you prioritise the care for that patient?
  • How you can link the information you have gained from this chapter into caring for a patient with a neurological condition and where the gaps in your knowledge are?


If you were caring for a patient with multiple sclerosis how you are going to nurse them. Consider what phase of their long term condition they may be in and consider what the priorities of care may be at their stage of the illness. Think about what the priorities of care will be and how you will prioritise the care for that patient. For example:

Problems with balance, walking and feeling dizzy are very common.

  • Patient may need input from physiotherapy for walking aids.
  • Ensure moving and handling assessments completed on patient.
  • Medication to prevent or help with dizziness.

Bladder problems are very common.

  • Bladder problems are common in people with multiple sclerosis. MS bladder symptoms include urinating more frequently, increased urges to urinate, difficulty emptying the bladder completely and frequently having to get up in the night to go to the toilet.
  • Ensure the patient is either near to the toilet or have a commode close by.
  • Ensure the patient can assess the nurse call button for assistance.
  • Ensure patient has dignity and privacy.

Constipation and bowel incontinence will be suffered by over 50% of patients sometime through their illness.

  • Ensure if the patient is constipated they are written up for medication to alleviate symptoms.
  • Ensure patient has a balanced diet.
  • For bowel incontinence try to establish a comfortable bowel routine.
  • Ensure the patient has not taken too much medication in relation to constipation.
  • An anti-diarrhoea drug like loperamide can be given to stop leakage and diarrhoea.
  • Ensure the patient has dignity and privacy.

Many patients with MS will experience problems with their vision and it is often an early sign of the disease.

  • Optic neuritis is the name for inflammation of the optic nerve. This is the nerve that carries messages from the eye to the brain. The effect it can have someone’s sight varies, from blurred vision to complete loss of sight.
  • The two most common eye movement problems in MS are double vision (diplopia) and involuntary eye movements (nystagmus).
  • Patients will need assistance with moving around the ward if not familiar.
  • Ensuring patients can eat and drink with assistance if needed.

Overwhelming tiredness is one of the most common signs of MS

  • Fatigue is an overwhelming sense of tiredness that often occurs after very little activity.
  • Fatigue may be caused by the effects of MS on the central nervous system, but other things – heat, side effects of drugs, or other MS symptoms – may play a part.
  • Ensure patient has adequate time to rest.
  • Carry out interventions when necessary.

The emotional effects of MS often go unnoticed.

  • A variety of factors can contribute to mood, emotional and behavioural changes. They might be due to MS-related nerve damage, a psychological reaction to MS, depression or the side effects of drugs.
  • Ensure the patient is observed and supported when necessary.

About a third of patients with MS will suffer from pain

  • Pain can be one of the most difficult ’invisible’ symptoms to describe. Pain might feel like squeezing, crushing, cold, hot, stabbing or burning, or tightness in the chest.
  • Refer to pain team
  • Treat with medication

Muscle stiffness and spasticity effects the activities of daily living

  • Muscle spasms or stiffness affect at least 20 per cent of people with MS at some time. Like all MS symptoms, spasms and stiffness affect people differently and can vary over time.
  • Treatment needs to be tailored to the patient’s needs.
  • Management might include physiotherapy and exercise, drug treatments, electrical stimulation therapies, TENS, surgery or aids and equipment.

30–40% of patients will experience difficulty with swallowing

  • MS can cause swallowing difficulties if there is damage to any part of the brain that controls swallowing, or damage to the connections between the brain and the spinal cord (the ‘brainstem’). These can be temporary.
  • Refer to the patient to speech and language for support.
  • Ensure the patient eats in an upright position.
  • Encourage the patient to eat slowly.