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Discuss About The Defining The Clinical Course Of Multiple Sclerosis.

Identification Of The Three Nursing Care Priorities

Multiple Sclerosis (MS) is a condition that affects the brain and the spinal cord or the nervous system and has the potential to lead to disability. It arises as a result of the immune system attacking the myelin that protects the nerve fibers and this leads to difficulties in communication between the brain and the body (Jacques & Lublin, 2015). The signs and symptoms generally depend on the extent to which the nerves are damaged. Some notable signs and symptoms however include fatigue, blurred vision and difficulties in the bladder functions (Dendrou, Fugger, & Friese, 2015). In this assignment, there is a case study of a patient who is likely to be suffering from MS. There will be presentation of the scenario, important information, processing of the information, identification of problems, established goals, the nursing interventions, evaluation, reflection and conclusion regarding the case study. This condition commonly occurs in the older people. In this assignment, I will utilize the Millers Functional Consequences Theory to identify the influences that impact old people and their level of functioning. In so doing, I will utilize the Levett Jones Clinical Reasoning Cycle as the tool to drive the whole process.

The patient in this scenario is an 83 year old widower called Mr. Dinh Nguyen. The patient was diagnosed with multiple sclerosis six years ago. He was also diagnosed with osteoarthritis four years ago and currently he is on medication. The patient migrated from Vietnam in 1976 and he currently lives alone in a two story home where he lived with his wife called Ngoc until her death twelve Months ago. Since then, the patient has been independent. With the ongoing grief however, the patient has noticed that there is a decline in his general health because of the worsening exercabations of the Multiple Sclerosis. Since Dinh and Ngoc never had any child, he has no immediate family. He only has his brother who is called Bao and his family that lives close to Dinh. The patient does not however feel like involving them in his life as it will be a bother to them.

The patient is always very careful with his little money .He said that he has a small income from his superannuation which he cares by himself. This gives him some form of financial independence. But since the investment are few, the returns are only used to cover his expenses. He often goes on holiday once a year but this year he did not make due to the altered mobility.

Cues/Information

The patient noted that he has been experiencing blurred vision, numbness in the face as well as an electric shock type of feeling whenever he tries to move his head and neck. This shock usually travels down the back up to his legs and this negatively impacts his movements as well as gait. It is this shock however that makes it difficult for him to accomplish tasks such as cooking, showering and dressing very difficult. Bending down to do up the shoe laces is also difficult for him. Recently Mr.Dinh has started experiencing urinary incontinences. Dinh feels that the condition is getting worse and he has started getting worried with uncertainty of his future. The current medications include Panadol osteo 6/24 oral prn a maximum of 6 per day. There is also the Teriflunomide 14mg which is administered orally on a daily basis. Finally, there is prednisolone 25 mg that is also administered orally BD whenever there is an exacerbation.

Some of the important cues or information from the case study include urine incontinence. Mr. .Dinh reported recent urine incontinence .The patient also noted of blurred vision and numbness in the face. He also feels an electric shock kind of feeling whenever he tries to move his head and neck. The patient was also diagnosed with Multiple Sclerosis four years ago. There are also cases of exacerbations since the patient noted that the situation has begun to get worse.

From the case study, it was established that the patient had urinary incontinence. Urinary incontinence is typical of the patients who are suffering from multiple sclerosis. Fatigue and altered mobility are also common signs and symptoms. This is due to the electric shock kind of feeling that starts at the head and the neck whenever the patient tries to move and it moves at the back up to the legs and this renders the patient immobile therefore needing moving aids such as wheelchairs.

From the case study, there are several health problems that can be identified. One of the problems is impaired Urinary elimination .This is because Mr. Dinh mentioned in the assessment that he had started experiencing urine incontinence. According to the Millers functional consequences theory, ageing has the potential to affect the functioning of some parts of the body(Bramble, 2012). For urine incontinence, the likely reason might be inelastic muscles in the bladder that makes it impossible to eliminate urine. Self-care deficit is another problem identified from the case study. The patient describe a form of electric shock that travels form the head and the neck through the back to his legs (Jangi et al., 2016). This form of shock makes it difficult for the patient to bend and carry out simple activities like showering, cooking as well as tying up his shoe laces. Another problem that was identified in the case study was the risk for Care giver role strain (Rocca et al., 2015). This is because the patient mentioned that he has a brother who is called Bao but he doesn’t want to involve them since he feels he would be bothering them. Fatigue is the final health problem identified in the case study. Mr. Dinh has been going on holiday once a year but this is now impossible due to fatigue that arise as a result of altered mobility.

Processing Of Information

Based on the established health problems, there are different goals that are set to be achieved during the nursing intervention. For the problem of fatigue, the identified or established goals include identifying alternative that can help the patient maintain a desired level of activity (Rotstein, Healy, Malik, Chitnis, & Weiner, 2015). Another goal is to identify potential risk factors and the individual actions that can affect fatigue .Finally, the patient is also to participate in the recommended treatment plan and report an improved sense of energy(Murrell, 2012) .For urinary incontinence ,the established goals include free urine leakage and ability to completely empty the bladder completely.

For fatigue or altered mobility, the nursing interventions include noting down and accepting the presence of fatigue. According to studies, fatigue is the most common symptom among patients suffering from Multiple Sclerosis (Ransohoff, Hafler, & Lucchinetti, 2015). This is because they spend very little energy which has a disproportionate impact on the ADLs and has a very slow recovery rate (Browne et al., 2014). The nurse should also identify and review any factors that affect ability of the patient to be active such as temperature extremes, inadequate food intake, insomnia, medications and finally the time of the day. The rationale for this intervention is to offer an opportunity to improve on the mobility of the patient.

The nurse should accept whatever the patient cannot do and he or she should also determine the need for walking aids, providing braces, walkers or even the wheelchairs. The nurse is also supposed to review the different safety considerations(Belbasis, Bellou, Evangelou, Ioannidis, & Tzoulaki, 2015) .The rationale for the mobility aids is to decrease fatigue while enhancing independence as well as comfort and safety. The only set back with this type of intervention is that the patient might develop a poor judgement on the ability to safely engage in different activities (Veroni, Serafini, Rosicarelli, Fagnani, & Aloisi, 2018). Concerning accepting whatever the physical activity the patient cannot accomplish, the nonjudgmental acceptance of the patient’s evaluation offers an opportunity to promote independence of the patient while at the same time assisting fluctuations in the level of the care needed.

The nurse is supposed to schedule ADLs early in the morning in case they are appropriate and planning for consistent periods of rests as well as afternoon naps. The nurse is also supposed to provide physical therapy and boost the patients comfort by massaging them and placing them in relaxing baths (Thompson et al., 2018). The rationale for all these is just reduce the level of fatigue and the aggravation of different muscles weaknesses.

Identification Of The Problem

Finally, the nurse should administer prednisone which as a steroid as prescribed. The rationale for this medication is to reduce the development of edema as well as the sclerotic plaques (Filippi et al., 2016).It should however be noted that long term treatment with the drug has very little effect on how the symptoms progress.

For urine incontinence, the nurse is supposed to review the drug regimen and then institute bladder training as appropriate. The patient should also be encouraged to take enough fluids and note the urinary frequency, nocturia and palpating of the bladder after each session of voiding (Banwell & Yeshokumar, 2017). The rationale for all this is just to provide information about the possible interference in urine elimination and this assists in restoring adequate bladder functioning. The patients should also be encouraged to be mobile frequently. The rationale is to prevent the likelihood of developing Urinary Tract Infections (Mahad, Trapp, & Lassmann, 2015). Finally, the nurse should refer the patient to the urinary continence specialist and this is just to ensure that the patients’ needs are met.

After the nursing interventions, Mr. Dinh is now able to completely empty his bladder. The patient can also not develop edema as well as sclerotic plagues due to the treatment using prednisone. This drug causes loss of excess fluids in the body (Giovannoni et al., 2015). The patient is also able to move around freely due to the physical therapy provided by the nurse.

I have really learnt a lot form this case study .I have gained a lot of knowledge regarding Multiple Sclerosis. There are things that I would however do differently in the future. I have realized that instead of focusing on ADLs alone ,resting periods are also important and I would also prefer to utilize relaxing baths for the patient The overall nursing experience for the Multiple sclerosis has however been well and I am looking forward to handle such a scenario again.

Conclusion

The condition affects the patient’s mobility. Some of the common signs and symptoms of MS include fatigue, blurred vision and numbness in the face. Urinary incontinence is also common among patients of the condition. The established goals in MS include ability to completely empty the bladder, improve on the physical mobility of the patient and reduce fatigue among the patients. There are different nursing interventions for MS and they include administering different medications such as prednisone to prevent exacerbation and edema. The nurse should also note the urinary frequency and urgency and review the treatment regimen. The patient should also be encouraged to take adequate fluids and promote continued mobility.

Established Goals

References

Banwell, B., & Yeshokumar, A. (2017). Diagnostic Challenges in Pediatric Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder. Journal of Pediatric Neurology, 16(03), 185-191. doi:10.1055/s-0037-1604421

Belbasis, L., Bellou, V., Evangelou, E., Ioannidis, J. P., & Tzoulaki, I. (2015). Environmental risk factors and multiple sclerosis: an umbrella review of systematic reviews and meta-analyses. The Lancet Neurology, 14(3), 263-273. doi:10.1016/s1474-4422(14)70267-4

Browne, P., Chandraratna, D., Angood, C., Tremlett, H., Baker, C., Taylor, B. V., & Thompson, A. J. (2014). Atlas of Multiple Sclerosis 2013: A growing global problem with widespread inequity. Neurology, 83(11), 1022-1024. doi:10.1212/wnl.0000000000000768

Bramble, M. (2017). Nursing for wellness in older adults S. Hunter and C. Miller. Wolters Kluwer, Philadelphia, 2016. ISBN 9781922228758 (paperback). Australasian Journal on Ageing, 36(1), 77-77. doi:10.1111/ajag.12387

Dendrou, C. A., Fugger, L., & Friese, M. A. (2015). Immunopathology of multiple sclerosis. Nature Reviews Immunology, 15(9), 545-558. doi:10.1038/nri3871

Filippi, M., Rocca, M. A., Ciccarelli, O., De Stefano, N., Evangelou, N., Kappos, L., … Barkhof, F. (2016). MRI criteria for the diagnosis of multiple sclerosis: MAGNIMS consensus guidelines. The Lancet Neurology, 15(3), 292-303. doi:10.1016/s1474-4422(15)00393-2

Giovannoni, G., Turner, B., Gnanapavan, S., Offiah, C., Schmierer, K., & Marta, M. (2015). Is it time to target no evident disease activity (NEDA) in multiple sclerosis? Multiple Sclerosis and Related Disorders, 4(4), 329-333. doi:10.1016/j.msard.2015.04.006

Jacques, F. H., & Lublin, F. D. (2015). Defining the clinical course of multiple sclerosis: The 2013 revisions. Neurology, 84(9), 963-963. doi:10.1212/01.wnl.0000462309.76486.c5

Jangi, S., Gandhi, R., Cox, L. M., Li, N., Von Glehn, F., Yan, R., … Weiner, H. L. (2016). Alterations of the human gut microbiome in multiple sclerosis. Nature Communications, 7, 12015. doi:10.1038/ncomms12015

Mahad, D. H., Trapp, B. D., & Lassmann, H. (2015). Pathological mechanisms in progressive multiple sclerosis. The Lancet Neurology, 14(2), 183-193. doi:10.1016/s1474-4422(14)70256-x

Murrell, K. (2012). Simulation simplified – a practical handbook for nurse educators Sandra Goldsworthy Simulation simplifi ed – a practical handbook for nurse educators and LeslieGraham Wolters Kluwer Health/Lippincott Williams & Wilkins 140pp £22.50 978 1 4511 4470 3. Nursing Standard, 27(10), 30-30. doi:10.7748/ns.27.10.30.s39

Ransohoff, R. M., Hafler, D. A., & Lucchinetti, C. F. (2015). Multiple sclerosis—a quiet revolution. Nature Reviews Neurology, 11(3), 134-142. doi:10.1038/nrneurol.2015.14

Rocca, M. A., Amato, M. P., De Stefano, N., Enzinger, C., Geurts, J. J., Penner, I., … Filippi, M. (2015). Clinical and imaging assessment of cognitive dysfunction in multiple sclerosis. The Lancet Neurology, 14(3), 302-317. doi:10.1016/s1474-4422(14)70250-9

Rotstein, D. L., Healy, B. C., Malik, M. T., Chitnis, T., & Weiner, H. L. (2015). Evaluation of No Evidence of Disease Activity in a 7-Year Longitudinal Multiple Sclerosis Cohort. JAMA Neurology, 72(2), 152. doi:10.1001/jamaneurol.2014.3537

Thompson, A. J., Banwell, B. L., Barkhof, F., Carroll, W. M., Coetzee, T., Comi, G., … Cohen, J. A. (2018). Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. The Lancet Neurology, 17(2), 162-173. doi:10.1016/s1474-4422(17)30470-2

Veroni, C., Serafini, B., Rosicarelli, B., Fagnani, C., & Aloisi, F. (2018). Transcriptional profile and Epstein-Barr virus infection status of laser-cut immune infiltrates from the brain of patients with progressive multiple sclerosis. Journal of Neuroinflammation, 15(1). doi:10.1186/s12974-017-1049-5

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