What are MS patients like?

Nurses General Nursing

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Specializes in Hem/Onc/BMT.

There is a resident at my LTC with quite advanced MS. I know about its physical symptoms but can't find a description of what it can do to mental state. He's extremely labile, so easily angered with smallest triggers -- another resident's wheelchair blocking his way, busy nurses not hearing what he said, etc. We had several altercation incidents due to his outbursts.

He grabs things from the medication cart, and when asked to return them, he becomes angry. I've already had my pens, BP cuff, stethoscope, hurled at me even when I tried to be gentle in asking them back.

Also he's depressed and very forgetful.

The only time he's not quick to anger and physical violence is when his wife (who visits daily) is there with him.

Is such personality change seen with advanced MS? Or is it something else? Could you share any experience dealing with MS patients? Any advice dealing with his behaviors? Setting boundaries doesn't work, it only makes him more violent.

Specializes in Family Nurse Practitioner.

Sadly depending on where the lesions are located people with MS can have personality changes, cognitive difficulties and impulse control issues. In my experience this is more the exception rather than the rule. Personally I would deal with this patient like you would someone with dementia and just do your best. FWIW the other possibility is that this guy was just jerk before MS also.

Specializes in Hem/Onc/BMT.

Thank you for the reply.

I'm happy to hear that it's more the exception. (Although it does not change the fact that I'm still stuck with this guy...)

FWIW the other possibility is that this guy was just jerk before MS also.

Haha, definitely that's possible, but I don't think so. He can be so sweet when he's in the right mood. He gave me a kiss on the cheek just today because I gave him the pen he so coveted. :)

Specializes in LTC, ALF.

All of the people with MS that I have encountered have been pleasant to work with and were some of my best patients. Maybe he has some other cognitive issues on top of his MS

I've had patients with MS who had extremely difficult personalities. These patients were not demented, but I thought that the disease was affecting them, beyond the stress of having such a condition in the first place.

I think your patient's doctor should consider a psych consult, or some meds for depression, agitation, pain, or get him counseling. He must be miserable, and his behavior will interfere with the care of the other patients.

I dread working with LTC residents whom have MS. First, poly-pharmacy is their norm. Up to 15 meds at a round, with half being narcotics, tranquilzers, etc. They make demands that require unreasonable amounts of time to please them. Working with them 12 hours each day for months on end can really drain you. MS patients contributed to my burn-out a few years back. Even utilizing the lifts, it was never enough help because this woman was in so much pain. She used her electric wheelchair to go into the Administrators office each week with complaints. Finally i left that job because i needed to be away from this woman with MS.

Specializes in Med/Surg, Geriatric, Hospice.

I've heard nurses describe them as manipulative, controlling, and contriving often times against anyone and everyone around them. I do see some of these qualities in many MS pt's. I don't know if these changes are organic or a coping mechanism for the lose of 'control' of their own bodies, they try to control everything around them and become manipulative to others.

Agreed, Cat LPN. Unfortunately, over time, you get sick of seeing good aids fired because of them. You burn out trying to please a person that may or may not have ineffective coping skills. You dread shower day for the obvious reasons. Some of these MS people are toxic...to the staff....to the nurses. Literally, an extended stretch of time caring for these people can suck the very kindness out of your heart.

Specializes in Acute Care, CM, School Nursing.

I've never worked with a patient with advanced MS. So, this thread is very interesting and informative to me. :up:

Specializes in Medical.

Cognitive changes, including lability, impaired impulse control, personality changes, problems with abstract concepts, verbal fluency, visual perception, memory and attention issues, and slowed information processing are common with MS, but often overlooked and poorly addressed. Other issues, including depression, fatigue, illness, stress and heat intolerance (common in MS) tend to make these issues worse. Some studies indicate as many as 2/3 of people diagnosed with MS will develop some form of altered cognition due to their illness.

Specializes in Family Nurse Practitioner.

While I appreciate your experiences and have no problem with venting it makes me sad for both the patient with MS and the caregivers you describe. I would just ask you try to remember that many of these people in LTC with MS are years younger than anyone would ever imagine having to live their life that way. MS is a nasty thief of a disease that is poorly understood. :(

do not allow him to get away with throwing things at you - or with stealing them from you to begin with.

as a team, nurses, doctors, social worker, therapists, the patient, his family, the chaplain or his own spiritual counselor of choice, etc. - all of you need to make a care plan that will help change his behavior. ms or not, he does not have the right to steal things (what if he stole a cup of someone else's meds?) or to throw things at you. believe me, you are the one who will be in trouble if he takes someone else's meds because you are supposed to be in control of your med cart at all times. and if he breaks things or loses them, well, again, you will probably suffer. it's not your fault he has ms and he needs to quit taking out his self-pity and anger on you.

figure out what rewards are to him - tv time? doing crafts? computer usage? listening to music? special food? visits from the doggies? take these away for inappropriate behavior. return them when he acts right. limits, corrective actions, discipline, rewards. also, is there any staff with whom he gets along very well? figure out what they're doing and see if you can emulate it.

are you familiar with dr. zamboni's surgery for curing ms? google that. being cured would probably help him behave a whole lot better.

as for what ms patients are like - well, their nervous system is falling apart. as you see, they are labile, angry, frustrated, full of fear and self-pity. who can blame them? but it does not help them to be allowed to take it out on other people.

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