Providing care for patients with Multiple Sclerosis
People who are severely affected by MS can often find that their quality of life is greatly reduced. Without adequate care and support, individuals with MS can become isolated and at more of a health risk. It is therefore vital that your care home staff are educated on how to effectively provide care for patients with multiple sclerosis.
Here are the main symptoms of MS with useful guidance on how you can assist residents in managing them:
Loss of Bladder Control
Incontinence occurs when the nerves and muscles of the urinary system don’t work together properly. The bladder may become underactive or overactive. Leaking, discomfort, or difficulty starting the urine stream can occur as a consequence.
The National Association for Continence suggests that individuals begin treatment for incontinence with remedies such as medications, absorbent products and bladder training. If the problem continues, you can consider more invasive options for your patients such as an insertion of a suprapubic catheter; a tube inserted into the bladder through the abdomen. This is a surgical procedure that allows urine to empty directly from the bladder into an external collection bag. If you take an individual to a nurse or physician, they can check how much urine is left in the bladder after a person urinates by doing a catheterization or by using a bladder scanner. It is vital for those with severe MS and incontinence to be periodically evaluated by a urologist due to the risk of urinary tract infections and other urinary complications. Urologists are able to do a thorough bladder evaluation on people suffering from incontinence called a urodynamic study.
Bowel problems and faecal incontinence are also common problems for individuals with MS. If residents in your care home suffer from bowel problems, you can try the following tips to help them to deal with it effectively:
> Maintain a regular bowel program if possible. It is useful to establish a regular time for emptying the bowels. Unfortunately, the disease might block the natural increase in activity of the colon following meals, however 30 minutes after breakfast is a good time to try to benefit from the gastro-colic reflex, a reflex that stimulates a wave of contractions in the bowel. Try to wait no more than 2-3 days between bowel movements
> Ensure individuals have access to the right equipment. Provide aids such as a commode chair or elevated toilet for comfort during the bowel routine.
You can shop our range of commode chairs here if you require aids to assist your clients.
Mobile Commode Chair
An occupational therapist or physical therapist can prescribe the right equipment to help you with the process.
> Maintain fluid intake. Try to have your loved one drink several glasses of water daily. Cutting back on fluid intake makes constipation worse. Lack of water may harden the stool, making it 39 more difficult to pass. In addition, increased pressure from the stool on the urinary system may increase bladder problems
> Encourage drinking something hot as the first beverage in the morning, such as tea or prune juice, to help stimulate a bowel movement. People with MS who have swallowing problems should use thickeners as needed
> Ensure residents maintain fibre intake. Eating plenty of fresh fruits, vegetables, whole-grain breads and cereals is the best way to maintain the amount of fibre in the diet
> Encourage exercise. If physical activity is not possible, active or passive range of motion may increase bowel motility
> Ensure patients have medication reviews with a nurse or doctor. Some types of drugs commonly taken in MS are known to cause constipation, therefore it may be possible to switch to a similar drug that won’t affect the bowels, or perhaps just a change to a different dose of the medication
> Schedule a bowel routine. Try to establish a regular routine for bowel movements. A set routine can help encourage the bowel to develop a regular pattern
> Encourage exercises for strength and control. Squeezing the muscles that control voluntary exit of stool may help strengthen them and thereby improve control
> Consider a rehabilitation program. A physical therapy or occupational therapy program is sometimes recommended for strengthening exercises and to assist with the bowel routine and the use of proper equipment
People with MS can experience sharp facial pain called trigeminal neuralgia. This can be brought on by facial movements as simple as yawning or grinning. Individuals may also feel pain in their legs. TN is often described as burning, aching, twitching or muscle cramping. It may even be experienced as an electric shock-like pain called Lhermitte’s sign. This sensation travels from the head to the spine. Another pain unique to MS is called Dysesthesia. This is a burning, tingling or numbness that can wrap around the waistline.
Common types of pain that those with MS may experience include the following:
> Brief muscle twitching or sudden, sharp muscle pain; may also burn or tingle
> Migraines, tension, or cluster headaches
> Eye pain
> Muscle cramping, pulling and pain
> Pain caused by the physical stress of immobility (Musculo-skeletal pain)
> Pain caused by MS treatment, such as steroid-induced osteoporosis, interferon side-effects, injection site reactions
> Pain associated with pressure sores, stiff joints, muscle contractures, urinary retention, urinary tract infection and other infections
MS pain may respond to a number of different medications or other treatments. It may be possible to wrap painful legs or hands in pressure stockings or gloves, which may convert the sensation of pain to one of pressure. Applying a warm compress to the areas in pain can also often be helpful. If an individual finds it difficult to express themselves, you can ask the person if there is any pain and how severe it is on a scale from 0 to 10. Facial expressions such as grimacing, frowning, looking sad, or wrinkling the brow can be an indication of pain. You can also note whether there is clenching fists or pulling at or touching a body part or area. Pain can also be assessed by observing usual activities. It is also useful to look at people’s ability to rest and sleep and whether they are unable to enjoy recreational activities, such as watching television and reading
Once any of these respiratory problems are observed, a physician should be notified immediately:
> Increasing frequency or difficulty swallowing foods and fluids
> Food not being chewed well
> Coughing becoming more frequent
> Mucous from the mouth or nose no longer clear
> Respirations becoming quicker and labored
> Increased fluid build-up
> Fever develops (you should already know at what temperature your doctor wants to be notified)
> Complete obstruction of the airway, even if only one time, necessitating use of the Heimlich Maneuver
Because weakness of the ventilatory muscles can occur at any time, many MS specialists recommend periodic evaluations every 1-3 years. You should, therefore, ensure patients have frequent evaluations with a physical therapist or nurse with special training in this area. In the event that respiratory function becomes affected, a therapy program can be recommended to strengthen ventilatory muscles and enhance respiration.
According to the National Multiple Sclerosis Society, fatigue occurs in 80 percent of patients who suffer from Multiple Sclerosis. In particularly hot or humid weather, fatigue may increase throughout the day. As fatigue can also be caused by treatable medical conditions such as depression, thyroid disease or anaemia, it is worthwhile consulting a physician if fatigue becomes a problem in residents with MS. A comprehensive evaluation can help identify the factors contributing to fatigue and make it possible to develop an approach suited to the individual’s needs. Some options for reducing symptoms of fatigue in individuals include:
> Encourage sleep regulation. This might involve treating other MS symptoms that interfere with sleep, such as spasticity, urinary problems and using sleep medications on a short-term basis
> Consider occupational therapy for people with MS to simplify tasks. Occupational therapists may alter the way residents do a task or help them to relearn how to do something
> Physical therapy to learn energy-saving ways of walking and performing other daily tasks, and to develop a regular exercise program
> Contact a specialist to find out information about appropriate medications. Amantadine Hydrochloride (Symmetrel®) and Modafinil (Provigil®) are the most commonly prescribed drugs. While neither is approved specifically by the U.S Food and Drug Administration (FDA) for the treatment of MS-related fatigue, each has demonstrated some benefit in clinical trials