What is the recommended nursing care for a patient experiencing a multiple sclerosis relapse?

Nursing Care for Multiple Sclerosis Relapse

The cornerstone of nursing care for multiple sclerosis relapse is administration of high-dose methylprednisolone (typically 1000 mg IV daily for 3-5 days), along with comprehensive symptom management, rehabilitation support, and psychosocial care. 1, 2

Pharmacological Management

Corticosteroid Administration

• Intravenous methylprednisolone is the first-line treatment for MS relapses, typically administered at 1000 mg daily for 3-5 days 1, 2
• Oral high-dose methylprednisolone (1250 mg/day for 3 days) is an effective alternative to IV administration with similar efficacy 3
• Monitor vital signs before and during administration of IV methylprednisolone to detect potential adverse reactions 1, 4
• Administer methylprednisolone in the morning to minimize sleep disturbances 1, 4

Medication Management

• Assess for potential drug interactions with methylprednisolone before administration 1
• Monitor blood glucose levels during corticosteroid treatment, especially in patients with diabetes or at risk for hyperglycemia 1, 4
• Administer gastroprotective agents if indicated to prevent gastrointestinal complications 4
• Consider monthly methylprednisolone pulse therapy (1g IV) as add-on therapy to disease-modifying treatments in patients with frequent relapses 5

Symptom Management

Neurological Assessment

• Perform regular neurological assessments using standardized tools like the Expanded Disability Status Scale (EDSS) to monitor response to treatment 2
• Document baseline neurological function and monitor for improvements or deterioration during treatment 6, 2
• Assess for new or worsening symptoms that may indicate treatment failure or disease progression 6

Rehabilitation Support

• Implement early rehabilitation interventions during the acute phase with gentle mobilization when medically stable 7
• Adapt exercise intensity based on platelet counts; exercise is contraindicated if platelet counts are below 20 × 10⁹/l 7
• Provide respiratory support and exercises to optimize respiratory function 7
• Manage spasticity through proper positioning, range-of-motion exercises, and medication administration as prescribed 7, 2

Nutritional Support

Dietary Considerations

• Avoid supplementation with omega-3 fatty acids as they have not shown benefit in decreasing relapse severity 7
• Consider supplementation with omega-6 fatty acids which may provide some benefit in decreasing relapse severity 7
• Monitor nutritional intake and ensure adequate hydration during corticosteroid treatment 7

Monitoring and Follow-up

MRI Monitoring

• Facilitate MRI studies as ordered to evaluate treatment response and disease activity 7
• Subtraction MRI techniques may be used to better visualize new or enlarging T2 lesions 7
• Understand that the presence of new T2 lesions on a 6-12 month follow-up scan does not necessarily reflect suboptimal response to treatment 7

Relapse Assessment

• Document relapse characteristics including onset, duration, and severity of symptoms 6, 2
• Distinguish true relapses from pseudoexacerbations caused by infection, stress, or heat 6, 2
• Monitor for signs of steroid-resistant relapses that may require alternative treatments such as plasma exchange 2

Psychosocial Support

Patient Education

• Educate patients about the expected course of relapse recovery and potential residual deficits 6, 2
• Provide information about corticosteroid side effects including mood changes, insomnia, and increased appetite 1, 4
• Teach patients to recognize early signs of relapse to facilitate prompt treatment 6

Emotional Support

• Assess for anxiety and depression, which commonly occur during relapses 2
• Provide emotional support and referrals to mental health services as needed 2
• Encourage participation in MS support groups 2

Rehabilitation Phases

Four-Phase Rehabilitation Approach

• Phase 1 (Pre-treatment): Enhance neuromuscular systems and respiratory function through pre-habilitation 7
• Phase 2 (Weeks 0-4): Provide acute rehabilitation with gentle mobilization and optimization of respiratory function 7
• Phase 3 (Weeks 8-12): Implement subacute rehabilitation with more intense physical therapy when medically stable 7
• Phase 4 (Weeks 12-26): Transition to community rehabilitation to promote independence and reintegration 7

Special Considerations

Infection Control

• Implement strict infection control measures during corticosteroid treatment due to increased infection risk 7, 1
• Monitor for signs of infection, especially urinary tract infections which are common in MS patients 7, 1
• Ensure proper hand hygiene and aseptic technique during IV administration 1

Common Pitfalls to Avoid

• Avoid delaying treatment for a confirmed relapse, as early intervention improves outcomes 6, 2
• Do not confuse symptom fluctuations with true relapses; true relapses last at least 24 hours in the absence of fever/infection 6
• Avoid abrupt discontinuation of corticosteroids; tapering may be necessary for longer treatment courses 1
• Do not rely solely on vitamin D supplementation to manage relapses, as studies have shown inconsistent results in reducing relapse rates 7