Fatigue | Nursing Care Plan (NCP) for Multiple Sclerosis

Nursing diagnosis: Fatigue related to Decreased energy production, increased energy requirements to perform activities, Psychological and emotional demands, Pain or 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/Evaluation Criteria—Client Will
Energy Conservation
Identify risk factors and individual actions affecting fatigue.
Identify alternatives to help maintain desired activity level.
Participate in recommended treatment program.
Report improved sense of energy.

Nursing intervention with rationale:
1. Note and accept presence of fatigue.
Rationale: Persistent fatigue is the most commonly reported symptom. Studies indicate that fatigue occurs with 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 the clinical neurological status.

2. Identify or review factors affecting ability to be active, such as temperature extremes, inadequate food intake, insomnia, use of medications, or time of day.
Rationale: Knowledge of these factors provides an opportunity to develop effective measures to maintain or improve mobility.

3. Accept when client is unable to do activities.
Rationale: Activity intolerance can vary from moment to moment. Nonjudgmental acceptance of client’s evaluation of day-to-day functioning provides opportunity to promote independence and self-esteem.

4. Determine need for mobility aids, for example, canes, braces, walker, wheelchair, or scooter. Review safety considerations.
Rationale: Mobility aids can decrease fatigue, enhance independence and comfort, and promote safety.

5. Schedule ADLs and outside activities in the morning or over time or throughout the course of the day. Investigate use of air conditioning, cooling vest, light-colored clothing, and wide-brimmed hats, if appropriate.
Rationale: Fatigue commonly worsens when exposed to high temperatures due to weather, environmental heat, exercise, or fever. Some clients report lessening of fatigue with stabilization of body temperature.

6. Plan care with consistent rest periods between activities. Encourage afternoon nap.
Rationale: Consistent rest and activity reduces fatigue and aggravation of muscle weakness.

7. Stress need for stopping exercise or activity before fatigue is exacerbated.
Rationale: Pushing self beyond individual physical limits can result in excessive or prolonged fatigue and discouragement. In time, client can become very adept at knowing limitations.

8. Investigate appropriateness of obtaining a service dog.
Rationale: Service dogs not only can increase client’s level of independence, for example, balance and mobility assistance, but also can assist in energy conservation by carrying items in saddlebags, fetching, retrieving, and performing tasks, such as turning lights on and off.

9. Recommend participation in support groups that involve fitness, exercise, and other issues related to MS.
Rationale: Providing support resources can motivate the client to remain at optimal level of activity. Group activities must be carefully selected to meet client’s need(s) and prevent discouragement or anxiety.

10. Administer medications, as indicated, for example: Amantadine (Symmetrel) and pemoline (Cylert)
Rationale: Amantadine and pemoline help manage fatigue. Common side effects include increased spasticity, insomnia, and paresthesia of hands and feet.