Chapter 6 General wellness and
management strategies
CONTENTS
6.1Introduction----------------------------------------------------------------------------------------- 3
6.2Overview ---------------------------------------------------------------------------------------------- 3
6.3 Lifestyle modifications---------------------------------------------------------------------- 4
6.3.1Introduction ------------------------------------------------------------------------------------------------------------------------------------ 4
6.3.2 Learning objectives ---------------------------------------------------------------------------------------------------------------------- 4
6.4Complementary therapies in multiple sclerosis ----------------------- 7
6.4.1References---------------------------------------------------------------------------------------------------------------------------------------- 8
6.4.2 Suggested reading ------------------------------------------------------------------------------------------------------------------------ 9
6.5Coping with stress--------------------------------------------------------------------------- 10
6.5.1 Introduction ---------------------------------------------------------------------------------------------------------------------------------- 10
6.5.2 Learning objectives --------------------------------------------------------------------------------------------------------------------10
6.5.3 Symptoms that indicate increased levels of stress ---------------------------------------------------------10
6.5.4 Strategies to reduce stress --------------------------------------------------------------------------------------------------------11
6.5.5 References --------------------------------------------------------------------------------------------------------------------------------------13
6.6Progress check ----------------------------------------------------------------------------------14
6.7Progress check answers ------------------------------------------------------------------19
6.8Glossary---------------------------------------------------------------------------------------------- 24
CHAPTER 6 General wellness and management strategies
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A GUIDE TO BEST PRACTICE MULTIPLE SCLEROSIS SPECIALIST NURSING IN IRELAND
CHAPTER
6
General wellness and
management strategies
6.1 INTRODUCTION
In this chapter, some of the physical and psychological therapies commonly used by patients with multiple sclerosis
(MS) are described. Lifestyle modifications and stress-management strategies that promote overall general health
and wellbeing are also reviewed.
6.2 OVERVIEW
This chapter contains the following sections:
·
Lifestyle modifications
·
Use of complimentary therapies in MS
·
Coping with stress.
At the end of the chapter, please find a section entitled Progress check; this section tests your knowledge of the
information presented in the chapter.
CHAPTER 6 General wellness and management strategies
3
6.3 LIFESTYLE MODIFICATIONS
6.3.1 Introduction
Lifestyle modifications, such as proper diet and regular exercise, can improve patients’ overall health and wellbeing
and may assist patients in achieving their therapeutic goals. In addition, some physical and psychological therapies
may be beneficial to patients with MS.
In this section, lifestyle modifications and other non-pharmacological strategies that promote general health and
wellbeing in patients with MS are discussed.
6.3.2 Learning objectives
After completing this section, the reader will be able to:
Discuss the following lifestyle modifications that can improve overall patient health:
– Regular exercise
·
– Proper diet
– Reducing fat intake
– Achieving and maintaining a healthy body weight
Describe and compare complementary and alternative therapies use in the treatment of MS and MS-related
symptoms.
·
6.3.2.1 Regular exercise
Many physicians advise their patients with MS not to exercise in order to avoid elevations in body temperature
and fatigue. The benefits of exercise in MS have however been demonstrated in studies across time (Huisinga et
al, 2011; Petajan et al, 1996; Solari et al, 1999). Fatigue, motor, neurological function, and emotional state improved
significantly in people with MS who engaged in regular physical activity (i.e. three 40-minute sessions per week)
for 15 weeks (Petajan et al, 1996). People with MS who were assigned to 3 weeks of inpatient rehabilitation showed
an improvement in disability and overall health-related quality of life (Solari et al, 1999). Similarly, Huisinga et al
(2011) state that MS-related fatigue improves with elliptical (a stationary exercise machine used to simulate stair
climbing, walking, or running without causing excessive pressure to the joints) exercise and these patients benefit
from structured exercise.
Physical activity should be incorporated into daily living and may be increased by pursuing more active recreation and
eventually developing a structured exercise programme (Petajan & White, 1999). Nurses should therefore encourage
their patients to engage in a regular physical activity programme that has been designed in collaboration with a
physiotherapist and/or physician. For patients with MS exercise is beneficial to improve walking ability, energy levels,
physical function, and overall quality of life (Ronai & LaFontaine, 2011).
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A GUIDE TO BEST PRACTICE MULTIPLE SCLEROSIS SPECIALIST NURSING IN IRELAND
6.3.2.2 Diet
To promote healthy and well-balanced meal consumption, nurses should advise patients to plan their meals
according to the food pyramid (see Figure 6.1). For most people this may mean eating more carbohydrates, fruit
and vegetables. These guides recommend that foods from the following five food groups be consumed on a daily
basis. Variety of these foods is essential.
Figure 6.1. The food pyramid (www.newsperuvian.com/wp-content/uploads/2011/05/food-pyramid-5.jpg).
Fats, sweets and alcohol
Milk
2–3 servings
Meat and others
2–3 servings
Vegetables
3–5 servings
Fruits
2–4 servings
Grains, beans and starchy vegetables
6 or more servings
6.3.2.3 Reduce fat intake
It is important to note that even high-fat meals can be part of a healthy eating plan as long as these meals are
balanced with lower-fat meals on other days. Therefore, it is the average intake of fat over the course of weeks and
months that is important, not the fat content of each individual food and meal consumed. Horowitz (2011) – part 1
states that the relationship between a reduced fat diet and MS was first investigated in the 1940’s by Dr R. Swank.
These investigations were based on epidemiological studies of inland people, likely to eat more dairy and butterfat
compared to coastal people who consumed high levels of fish. In a 34 year observational study of 144 MS patients,
Dr Swank (Swank & Duggan, 1990) observed that those who consumed a low fat diet showed less neurological
deterioration. However, there are criticisms of the Swank and McDougall (another low fat diet) diets. Durand (2009)
CHAPTER 6 General wellness and management strategies
5
recognises that a low fat diet is beneficial to overall health but suggests that the scientific support for these diets
is unavailable, as the Swank long-term study was pre-magnetic resonance imaging (MRI) and therefore measuring
disease activity was not possible; this study also lacked a well-matched control group.
Patients following the guidance of the food pyramid may use some of the following strategies for
healthy eating:
Drink semi-skimmed or skimmed milk
Use low-fat salad dressings
Limit the use of vegetable oils, butter and margarine when cooking
Buy low-fat cottage cheese and yoghurt
Limit portion sizes of meat to 2–3 oz
Choose fish, poultry and beans instead of red meats
Limit the consumption of prepared foods that are fried or breaded
Use non-stick pans when cooking instead of oil or butter
Drain fat when cooking meats and poultry
Remove skin from poultry before cooking
Ensure adequate fluid intake.
·
·
·
·
·
·
·
·
·
·
·
6.3.2.4 Achieve and maintain a healthy body weight
Despite the vast amounts of money spent annually on weight-loss products and publicity, the prevalence of
the overweight and obese in Ireland was 24.6% in 2007 (Barron et al, 2009). In addition, the prevalence of eating
disorders, particularly among young women, is increasing dramatically. Carlson (2009) suggests that bulimia is an
eating disorder with increasing prevalence in society. The current preoccupation with body weight and body image,
and the relentless pursuit of thinness have prompted healthcare professionals to examine issues surrounding body
weight and weight management more intensely.
Many healthcare professionals believe that people need to focus on healthy living in general rather than focussing on
body weight alone. Healthy living involves eating well, being active, and feeling good about oneself. By following such
an approach, a healthy weight and vitality can be achieved in a positive and safe way. Thomas & Irwin (2009) observed
that perceived facilitators of a healthy body weight included family support, access to nutritious food at home and
encouragement to engage in physical activity.
A healthy body weight is often defined as a weight range appropriate for a particular height and body type. It is
also described as a weight at which the person feels energetic, fit, and flexible, and is at a lower risk of developing
weight-related health problems.
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A GUIDE TO BEST PRACTICE MULTIPLE SCLEROSIS SPECIALIST NURSING IN IRELAND
6.4 COMPLEMENTARY THERAPIES IN MULTIPLE
SCLEROSIS
Many MS patients use a variety of therapies to assist with the management of MS related symptoms; however, these
therapies are complementary to the medical treatments previously discussed in Chapter 3.
Some of the most commonly used physical, energy, and psychological complementary therapies in MS are acupuncture,
chiropractic, massage therapy, meditation, reflexology, Tai Chi, and yoga. Horowitz (2011) – part 2 describes a variety
of alternative therapies found to be beneficial in MS, for example yoga, reflexology and acupuncture. In a 1980 study
cited by Horowitz (2011) 57% of participants found yoga to be ‘very beneficial’. Horowitz (2011) also provides supporting
evidence for Ai chi (water-based t’ai chi) which has been shown to decrease fatigue, reflexology was found to produce
benefits when used for MS-related symptoms and the use of acupuncture was found to reduce MS-related symptoms.
Each of these therapies is described in Table 6.1.
Table 6.1. Commonly used physical, energy, and psychological therapies in MS:
THERAPY
DESCRIPTION
ADVANTAGES
DISADVANTAGES
Acupuncture
· A form of therapy in which
fine needles are placed along
a network of invisible energy
channels (called meridians)
with the aim of unblocking
these channels and allowing
energy to flow freely
throughout the body
· Goal of therapy is to promote
recovery from illness
· Releases endorphins and
therefore may reduce pain
associated with MS
· Does not alter disease
course
· Some patients
experience discomfort
during needle
insertion
Massage therapy
· A form of therapy that
involves kneading and
rubbing parts of the body
to promote circulation,
suppleness, or relaxation
· May relieve spasticity and
pain associated with MS
· May promote relaxation
and a general sense of
wellbeing
·Costly
· Effects are short-lived
Meditation
(for links on
information
regarding
mindfulness
meditation please
see suggested
reading)
· A form of therapy that
involves thinking about
something deeply or
reflecting deeply on spiritual
matters
· May help patients with
MS cope with the physical
and psychological
burdens of the disease
· May promote relaxation
·Requires
concentration and
therefore may be
difficult for those
patients with
cognitive impairments
Reflexology
· A form of therapy in which
the soles of the feet are
massaged
· May promote relaxation
·Costly
· Effects are short-lived
CHAPTER 6 General wellness and management strategies
7
Tai Chi
· A form of martial art that
focuses on coordinating
movements of the head, eyes,
arms, hands, body, and legs
with respiration; also involves
meditation
· May improve muscle
flexibility, balance, and
mental wellbeing
May reduce fatigue
Can be performed by
patients of any age or level
of disability, including
patients in wheelchairs
Inexpensive
·
·
·Requires
concentration and
therefore may be
difficult for those
patients with cognitive
impairments
·
Yoga
· A form of therapy that
involves physical and mental
exercises aimed at creating a
state of complete awareness
and tranquillity
· May increase flexibility and · Many of the exercises
muscle strength
are difficult for
patients with
· May promote relaxation
spasticity and other
mobility impairments
6.4.1 References
Barron et al. Prevalence rates and comparisons of obesity levels in Ireland. British Journal of Nursing 2009; 18(13): 799–803.
Carlson D. Necrotizing sialometaplasia a practical approach to the diagnosis. Archives of Pathology and Laboratory
Medicine 2009; 133(5): 692–698.
Durand (2009) The skinny on the Swank MS diet. Momentum (nationalMSsociety.org/magazine) pg 49-51.
Horowitz S. CAM Interventions for multiple sclerosis. Part 1. Diet and supplements for relieving symptoms. Alternative
and Complementary Therapies 2011; 17(3): 156–161.
Horowitz S. CAM Interventions for multiple sclerosis. Part 2. Integrative nondietary approaches. Alternative and
Complementary Therapies 2011; 17(4): 214–219.
Huisnga et al. Elliptical exercise improves fatigue ratings and quality of life in patients with multiple sclerosis. Journal of
Rehabilitation Research and Development 2011; 48(7): 881–890.
Lindsay Anne. Smart Cooking: Quick and Tasty Recipes for Healthy Living. Toronto: Macmillan Canada; 1996.
Petajan JH, Gappmaier E, White AT et al. Impact of aerobic training on fitness and quality of life in multiple sclerosis. Ann
Neurol 1996; 39: 432–441.
Petajan JH, White AT. Recommendations for physical activity in patients with multiple sclerosis. Sports Med 1999; 27:
179–191.
Ronai P, LaFontaine T. Multiple sclerosis and exercise. Strength and Conditioning Journal 2011; 33(1): 26–29.
Solari A, Filippini G, Gasco P et al. Physical rehabilitation has a positive effect on disability in multiple sclerosis patients.
Neurology 1999; 52: 57–62.
Thomas H, Irwin J. What is a healthy weight? Perspectives of overweight youths. Canadian Journal of Dietetic Practice
and Research 2009; 70(3): 110–116.
www.newsperuvian.com/wp-content/uploads/2011/05/food-pyramid-5.jpg [online] accessed 21/2/12.
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6.4.2 Suggested reading
www.sanctuary.ie/index.html – Further reading on Mindfulness meditation.
www.sanctuary.ie/resources.html – Further reading on Mindfulness meditation.
www.oscailt.com/category/mindfulness/ – Further reading on Mindfulness meditation.
Health Education Authority. Enjoy Healthy Eating – The Balance of Good Health; 1995.
CHAPTER 6 General wellness and management strategies
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6.5 COPING WITH STRESS
6.5.1 Introduction
‘According to the World Health Organization, stress is a significant problem of our times and affects both physical as
well as the mental health of people. Stress is defined as a situation where the organism’s homeostasis is threatened
or the organism perceives a situation as threatening’ (Varvogli & Darviri, 2011).
Early anecdotal reports suggested that both the onset and progression of MS may be influenced by stressful
life events, but its aetiological role is somewhat elusive (Ackerman et al, 1999). Studies are required to clarify the
mechanisms of this relationship and identify interventions to prevent or minimise stress-induced exacerbations.
Many of the studies undertaken suggest a relationship between stress and MS, but were not conclusive, due to lack
of controls and the absence of standardised methodology for assessing life events. Many patients with MS report
that they experience more symptoms during stressful periods. While extreme stress (injury) may induce a state of
immunosuppression that is beneficial to the person with MS, but chronic stress may alter the balance of the immune
system to facilitate activity. During periods of stress, people with MS require additional energy to perform everyday
tasks, each individual has different coping abilities and during this time, the abilities can be overstretched. At this time,
any difficulty, including dealing with MS symptoms, becomes more challenging.
6.5.2 Learning objectives
After completing this section, the reader will be able to:
·
Assist patients in identifying symptoms that indicate increased levels of stress
·
Assist patients in reducing and managing stress.
6.5.3 Symptoms that indicate increased levels of stress
Physical symptoms:
– Tension headaches
·
– Sweaty hands
– Faintness, fatigue, weariness
– Frequent colds and flu
– Pounding heart
– Teeth grinding
– Trouble sleeping
– Stomach aches, knots, cramps or nausea
– Short/shallow breathing
– Neck aches/back pain.
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A GUIDE TO BEST PRACTICE MULTIPLE SCLEROSIS SPECIALIST NURSING IN IRELAND
·
Psychological symptoms:
– Irritability or short temperedness
– Feeling anxious and nervous
–Nightmares
– Difficulty making everyday decisions
– Mood swings
– Feeling overwhelmed
– Expecting the worst to happen
– Continual boredom.
·
Behavioural symptoms:
– Social withdrawal
– Minor accidents
– Over/under eating
– Increase smoking/drinking
(Belshaw, 2005)
6.5.4 Strategies to reduce stress
Varogli & Darviri (2011) found a variety of evidence-based stress management techniques via literature review of
several databases.
The following are a selection of these methods:
·
Progressive muscle relaxation:
– Developed in the 1920s by Dr E. Jacobson
– Reduces stress and anxiety by alternative tensing and relaxing of muscles
– Long-term benefits include reduced anxiety, decreased blood pressure, heart rate and headaches, improvement
in quality of life in MS patients
·
Autogenic training:
– Developed by German psychiatrist Johannes Heinrich Schultz in 1926
– Involves the individual learning a set of exercises that allow the body to relax and control breathing, blood
pressure, heartbeat and body temperature
– Beneficial in a range of disorders; headaches, pain, anxiety and depression
·
Relaxation response:
– Developed by Herbert Benson in the 1960s
– Involves stimulation of areas of the brain in response to stress
– The programme characteristics include repetition of a word or sound and passive return to the repetition when
other thoughts intrude
CHAPTER 6 General wellness and management strategies
11
·
– This method has been shown to reduce hypertension and improve cardiac rehabilitation
Diaphragmatic breathing:
– This method of deep breathing involves expansion of the abdomen rather than the chest when breathing,
which leads to decreased oxygen consumption, decreased heart rate and blood pressure and increased
parasympathetic activity
– Diaphragmatic breathing has been used to successfully decrease fatigue, anxiety, migraine and aggressive
behaviour
Mindfulness-based stress reduction:
– Developed at the University of Massachusetts in 1979
·
– A structured 8-week program of mediation to alleviate mental and physical stress
– Successfully used for chronic pain, chronic disease, depression and anxiety.
Varvogli & Darviri (2011)
6.5.4.1 Thinking positively
To help reduce stress levels in their patients, nurses should promote positive-thinking patterns. Nurses can empower
patients to manage their own thinking by encouraging them to pay attention to their thinking, helping them to
identify how their thinking influences their feelings and emotions and providing guidance on how to keep positive.
For example, the patient may say, ‘I am a failure at everything I do!’ The nurse can respond to this negative statement
by saying, ‘You did a pretty good job this time – maybe we can try to do better next time.’
6.5.4.2 Talking it out
Nurses can also help patients relieve stress by encouraging them to talk about their thoughts, feelings, and opinions.
Building a support group of patients (as well as others) who know about their illness and the difficulties they face will
help patients cope. If the patient feels uncomfortable talking with family members or friends, nurses can suggest
contacting MS societies, which often have support networks. Many patients find it easier discussing their feelings
about the difficulties posed by the disease in the presence of a social worker or nurse.
6.5.4.3 Expressing anger
Sometimes patients relieve stress by expressing anger or frustration. Open and honest communication between
the nurse and patient can alleviate some anger caused by lack of insight and understanding. Nurses can explain to
patients that this is normal and acceptable provided that patients are not blaming others. For example, nurses can
encourage patients to say, “I’m so angry,” instead of, “You make me so angry.”
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A GUIDE TO BEST PRACTICE MULTIPLE SCLEROSIS SPECIALIST NURSING IN IRELAND
6.5.4.4 Other strategies
There are several ways in which patients can reduce their stress levels on a daily basis. Although each individual
needs to find his/her own manner in which to deal with stress, nurses can suggest a few of the following strategies
to their patients:
·
Simplify life by:
– Prioritising tasks
– Planning ahead for situations that may induce stress
– Obtaining more rest the day before a big event
– Learning to say “no” to requests from others
– Asking for help when they need it
·
Becoming more practical by:
– Doing chores as they arise; procrastination will only build stress at the end of the day
– Keeping the car and important appliances in good working order
– Using labour-saving devices
– Do unpleasant chores at the beginning of the day so that they do not need to be dealt with later
– Carry a notebook in which they write notes to themselves throughout the day
– Take deep breaths.
6.5.5 References
Ackerman KA, Heyman R, Rabin BS, Baum A. The International MS Journal 1999; 7: 9–17.
Interview with Belshw K. (2005) Under Pressure. MS news www.ms-society.ie/assets/0000/0065/summerissue_
msnews_76.pdf [online] accessed 21/2/12.
Varvogil L, Darviri C. Stress management techniques: evidence-based procedures that reduce stress and promote health.
Health Science Journal 2011; 5(2): 74–89.
CHAPTER 6 General wellness and management strategies
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6.6 PROGRESS CHECK
1.
European food guides recommend that adults eat at least __________ portions of bread, other cereals and
potatoes per day. These should make up to __________ % of our total daily intake.
2.
Most European food guides recommend that adults eat __________ portions of fruits and vegetables per day.
These should make up to __________ % of our total daily intake.
3.
European food guides recommend that adults consume __________ servings of milk and dairy products per
day, making up to __________ % or our total daily intake.
4.
It is recommended that adults eat __________ portions of protein per day, preferably leaner meats, poultry,
fish, dried peas, beans, and lentils. __________ % of our total daily intake should come from this food group.
5.
The final __________ % of our total daily intake should be made up from foods high in fat or sugar. They
should be used sparingly.
6.
Nurses should also encourage patients to eat __________ of fibre per day.
7.
Men may drink up to __________ units alcohol per day. Women may drink up to __________ units of alcohol
per day.
8.
List three strategies that can help patients reduce their salt intake.
a. ______________________________________________________________________________________________________
b. ______________________________________________________________________________________________________
c. ______________________________________________________________________________________________________
9.
List ten strategies that can help patients reduce their fat intake.
a. ______________________________________________________________________________________________________
b. ______________________________________________________________________________________________________
c. ______________________________________________________________________________________________________
d. ______________________________________________________________________________________________________
e. ______________________________________________________________________________________________________
f. ______________________________________________________________________________________________________
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A GUIDE TO BEST PRACTICE MULTIPLE SCLEROSIS SPECIALIST NURSING IN IRELAND
g. ______________________________________________________________________________________________________
h. ______________________________________________________________________________________________________
i. ______________________________________________________________________________________________________
j. ______________________________________________________________________________________________________
10. Complete the following deep-breathing instructions:
a.Sit ___________________________________________________________________
b. Place your hand on your belly, in order to feel your breathing
c. Inhale ________________________ and concentrate on __________________________
d. As the air reaches your belly, let your stomach muscles _______________________
e.Draw in as much air as you can and _______________________________________
f. When you start to exhale, _______________________________________________; concentrate _______________
___________________________________________
g. Feel your stomach muscles relax
h.When you have finished the deep breath, __________________________________
i. Repeat this procedure ________ to ________ times.
11. Complete the following relaxation exercise:
·
The nurse should help the patient through the entire relaxation programme the first time. The patient
should be wearing comfortable, ________________ clothes and should be sitting in a comfortable
chair. The focus should always be on how the muscles feel before, during, and after each individual
________________.
·
It is best to be in a chair with __________________________: use a cushion in the small of your back if it
helps and make sure you are warm.
·
Sit upright and well back in the chair so that your ________________________________ are supported.
CHAPTER 6 General wellness and management strategies
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16
·
Gently rest your ________________ on your lap or thighs. Let your feet rest on the floor.
·
Gently close your eyes. Make sure that your ________________ are gently resting over your eyes and
there is no tension or ________________.
·
Begin by breathing out….then slowly breathe in just as much air as you need and gently breathe out
with a ________________. Do this once more … gently breathe in and out and as you breathe out, feel
the ________________ begin to drain away. Keep your breathing nice and gentle with no effort involved
as we move our attention onto other things.
·
Now direct your thoughts to your body, to the ________________. Think first about your right foot, your
toes and your ankle. They are resting heavily on the floor. Let your ________________ sink down into the
mat and let your foot relax.
·
Now think about your left foot, _____________________________. Let that heel sink into the mat. Let both
your feet, your toes and your ankles ________________ and as they relax, they will start to feel warm and
heavy.
·
Now move your attention to your legs. Your thighs and knees roll outward as they relax, so let
them go …..and let your _____ flop to the sides. As the tension drains out of your muscles, let your
________________ relax and let the muscles spread as the tension drains away and your legs start to
become ________________ and heavy.
·
Now think about your spine and ________________. Let the tension drain away from your spine and
back. Follow your breathing and each time you breathe our, relax your spine and back a little more.
·
Let your ________________ muscles become loose…. There is no need to hold your stomach in tight, so
let it go and let it gently rise and fall as you breathe. There should be no tension in your chest. Keep
your breathing ________________ and without any effort. Remember each time you breathe out to let
the tension go.
·
Now think about your ________________. Your fingers are curved, ________________ and quite still. Now
your left hand….your fingers are soft and still. Let this feeling of ________________ spread up your arms
and let your arms feel warm and heavy as they start to relax.
·
Let this feeling spread to your neck and shoulders. Let your shoulders ________________ and, as the
tension eases away, let your shoulder blades spread and separate. Let your ________________ be
supported by the chair, so allowing your neck muscles to relax and the tension to ease away.
·
Before we move on, just check that all parts of your body are still relaxed. Your feet, legs, back and
spine, neck and shoulders. Keep your breathing ________________ and remember to let go of the
tension as you breathe out.
·
Now think about your ________________. Let the expression come off your face. Let your forehead feel
wide and smooth out your ________________. Let your ________________ drop. Make sure that your eyes
are just gently closed. Let your jaw unwind and your teeth part slightly as you relax. Feel the relief of
letting of as the tension drains away. Now think about your tongue. Let your ________________ to the
bottom of your mouth and relax completely. Relax your tongue and throat and your lips… lightly
together with no ________________ between them. Let all the muscles in your face unwind and let go
….just let it relax more and more.
A GUIDE TO BEST PRACTICE MULTIPLE SCLEROSIS SPECIALIST NURSING IN IRELAND
·
Now, instead of thinking about yourself in parts… think of yourself as a whole and feel the all over
________________ of letting go and of quiet and rest. Check to see if you are ________________.
·
Stay like this for a few moments and listen to your ________________ and let your body become heavier
with each breath you breathe out. Enjoy this time of ________________.
·
Coming back, slowly ________________ your hands a little and your feet. When you are ready, open your
eyes and sit quietly for a while. Stretch or ________________ if you want to, and slowly start to move.
Practising this relaxation can help reduce daily stress and prepare the patient for a good night’s sleep.
12. List eleven physical symptoms that indicate increased levels of stress.
a. ______________________________________________________________________________________________________
b. ______________________________________________________________________________________________________
c. ______________________________________________________________________________________________________
d. ______________________________________________________________________________________________________
e. ______________________________________________________________________________________________________
f. ______________________________________________________________________________________________________
g. ______________________________________________________________________________________________________
h. ______________________________________________________________________________________________________
i. ______________________________________________________________________________________________________
j. ______________________________________________________________________________________________________
k. ______________________________________________________________________________________________________
CHAPTER 6 General wellness and management strategies
17
6.7 PROGRESS CHECK ANSWERS
1.
European food guides recommend that adults eat at least 5 portions of bread, other cereals and potatoes per
day. These should make up to 33% of our total daily intake.
2.
Most European food guides recommend that adults eat at least 5 portions of fruits and vegetables per day.
These should make up to 33% of our total daily intake.
3.
European food guides recommend that adults consume 2–4 servings of milk and dairy products per day,
making 15% or our total daily intake.
4.
It is recommended that adults eat 2–3 portions of protein per day, preferably leaner meats, poultry, fish, dried
peas, beans, and lentils. 12% of our total daily intake should come from this food group.
5.
The final 7% of our total daily intake should be made up from foods high in fat or sugar. They should be used
sparingly.
6.
Nurses should also encourage patients to eat 30 gms of fibre per day.
7.
Men may drink up to 4 units alcohol per day. Women may drink up to 3 units of alcohol per day.
8.
List three strategies that can help patients reduce their salt intake.
a. Use pepper, herbs and other low-sodium spices instead of salt to flavour foods
b.Use half or none of the amount of salt recommended in recipes
c. Avoid convenience items, such as frozen meals, whenever possible since these foods tend to be
high in salt
9.
List ten strategies that can help patient reduce their fat intake.
a. Drink semi-skimmed or skimmed milk
b.Use low-fat salad dressings
c. Limit the use of vegetable oils, butter and margarine when cooking
d.Buy low-fat cottage cheese and yoghurt
e. Limit portion sizes of meat to 2-3 oz
f. Choose fish, poultry and beans instead of red meats
g.Limit the consumption of prepared foods that are fried or breaded
CHAPTER 6 General wellness and management strategies
19
h. Use non-stick pans when cooking instead of oil or butter
i. Drain fat when cooking meats and poultry
j. Remove skin from poultry before cooking
10. Complete the following deep-breathing instructions:
a.Sit upright with your shoulders comfortably back
b. Place your hand on your belly, in order to feel your breathing
c.Inhale through your nose and concentrate on the feeling of the air passing through your nose
d. As the air reaches your belly, let your stomach muscles expand
e. Draw in as much air as you can and hold it for a few seconds
f. When you start to exhale, shape your lips as if you are about to whistle: concentrate on the
feeling of the air moving through your lips
g. Feel your stomach muscles relax
h. When you have finished the deep breath, continue to sit silently in your chair
i. Repeat this procedure four to five times.
11. Complete the following relaxation exercise:
20
·
The nurse should help the patient through the entire relaxation programme the first time. The patient
should be wearing comfortable, loose-fitting clothes and should be sitting in a comfortable chair. The
focus should always be on how the muscles feel before, during, and after each individual exercise.
·
It is best to be in a chair with arms and a high back: use a cushion in the small of your back if it helps
and make sure you are warm.
·
Sit upright and well back in the chair so that your thighs and back are supported
·
Gently rest your hands on your lap or thighs. Let your feet rest on the floor.
·
Gently close your eyes. Make sure that your eyelids are gently resting over your eyes and there is no tension
or strain
·
Begin by breathing out….then slowly in just as much air as you need and gently breathe out with a
slight sigh. Do this once more … gently breathe in and out and as you breathe out, feel the tension
begin to drain away. Keep your breathing nice and gentle with no effort involved as we move our
attention onto other things.
·
Now direct your thoughts to your body, to the muscles and joints. Think first about your right foot,
your toes and your ankle. They are resting heavily on the floor. Let your heel sink down into the mat and
let your foot relax.
·
Now think about your left foot, your toes and ankle. Let that heel sink into the mat. Let both your feet,
your toes and your ankles start to relax and as they relax, they will start to feel warm and heavy.
A GUIDE TO BEST PRACTICE MULTIPLE SCLEROSIS SPECIALIST NURSING IN IRELAND
·
Now move your attention to your legs. Your thighs and knees roll outward as they relax, so let them go
…..and let you feet flop to the sides. As the tension drains out of your muscles, let your calves and
thighs relax and let the muscles spread As the tension drains away and your legs start to become warm
and heavy.
·
Now think about your spine and back. Let the tension drain away from your spine and back. Follow your
breathing and each time you breathe our, relax your spine and back a little more.
·
Let your abdominal muscles become loose…. There is no need to hold your stomach in tight, so let
it go and let it gently rise and fall as you breathe. There should be no tension in your chest. Keep your
breathing gentle and easy and without any effort. Remember each time you breathe out to let the
tension go.
·
Now think about your right hand. Your fingers are curved, limp and quite still. Now your left hand….
your fingers are soft and still. Let this feeling of relaxation spread up your arms and let your arms feel
warm and heavy as they start to relax.
·
Let this feeling spread to your neck and shoulders. Let your shoulders sag and drop and, as the tension
eases away, let your shoulder blades spread and separate. Let your head be supported by the chair, so
allowing your neck muscles to relax and the tension to ease away.
·
Before we move on, just check that all parts of your body are still relaxed. Your feet, legs, back and spine,
neck and shoulders. Keep your breathing nice and gentle and remember to let go of the tension as you
breathe out.
·
Now think about your face Let the expression come off your face. Let your forehead feel wide and
smooth out your brow. Let your eyebrows drop. Make sure that your eyes are just gently closed. Let
your jaw unwind and your teeth part slightly as you relax. Feel the relief of letting of as the tension drains
away. Now think about your tongue. Let your tongue drop to the bottom to the bottom of your mouth
and relax completely. Relax your tongue and throat and your lips… lightly together with no pressure
between them. Let all the muscles in face unwind and let go ….just let it relax more and more.
·
Now, instead of thinking about yourself in parts… think of yourself as a whole and feel the all over
sensation of letting go and of quiet and rest. Check to see if you are still relaxed.
·
Stay like this for a few moments and listen to your breathing and let your body become heavier with
each breath you breathe out. Enjoy this time of relaxation.
·
Coming back, slowly wriggle your hands a little and your feet. When you are ready, open your eyes and
sit quietly for a while. Stretch or yawn if you want to, and slowly start to move.
Practising this relaxation can help reduce daily stress and prepare the patient for a good night’s sleep.
Chart continued on the next page
CHAPTER 6 General wellness and management strategies
21
12. List eleven physical symptoms that indicate increased levels of stress.
a. Clammy hands
b.Constipation/diarrhoea
c. Dry mouth
d.Headache
e. Heart palpitations
f. Stomach aches, cramps
g.Muscle spasms
h. Lump in the throat
i. Fatigue/weariness
j. Sleeping too much/too little
k. Short and shallow breathing
22
A GUIDE TO BEST PRACTICE MULTIPLE SCLEROSIS SPECIALIST NURSING IN IRELAND
6.8 GLOSSARY
MS
MRI
24
Multiple sclerosis
Magnetic resonance imaging
A GUIDE TO BEST PRACTICE MULTIPLE SCLEROSIS SPECIALIST NURSING IN IRELAND