The patient with multiple sclerosis tells the nursing assistant that after physical therapy she is too tired to take a bath. What is your priority nursing diagnosis at this time?
A. Fatigue related to disease state
B. Activity Intolerance due to generalized weakness
C. Impaired Physical Mobility related to neuromuscular impairment
D. Self-care Deficit related to fatigue and neuromuscular weakness
Correct Answer: D. Self-care Deficit related to fatigue and neuromuscular weakness
At this time, based on the patient’s statement, the priority is Self-Care Deficit related to fatigue after physical therapy. Fatigue is described as an overwhelming feeling of lassitude or lack of physical or mental energy that interferes with activities.
Option A: The patient might be experiencing fatigue, but it might be due to the activities at physical therapy. Fatigue is one of the most common symptoms of MS, reported by at least 75% of patients with the disease.
Option B: Activity intolerance in a patient with MS is appropriate, but not related to the statement. An estimated 50–60% of persons with MS describe fatigue as one of their most bothersome symptoms, and it is a major reason for unemployment among MS patients.
Option C: Impaired physical mobility is appropriate to a patient with MS, but it is not related to the patient’s statement. Spasticity in MS is characterized by increased muscle tone and resistance to movement; it occurs most frequently in muscles that function to maintain an upright posture. The muscle stiffness greatly increases the energy expended to perform activities of daily living (ADLs), which in turn contributes to fatigue.