MULTIPLE SCLEROSIS DISEASE MANAGEMENT

Introduction of Case Study

• In this case the person is multiple Sclerosis patient. She is about 34 years of age.

• Patient feels that her left body portion is relatively weak, massive fatigue with a potential Lhermitte’s symptoms.

• After experiencing a mal seizure in the office she is taken in to the Emergency Department.

• MRI was conducted to identify the exact reason for seizure.

• Frequent diagnosis schedule with neurologist.

Case Study, Continued

• MRI results revealed that there are at least eleven spots where myelin sheath of the nerves is deteriorated. Myelin sheath is vital for the nerves and it acts like an insulator of the nerve. Demyelination cause poor nerve transmission.

• It is believed that multiple sclerosis is a genetic disease. However, viral infection and auto immune response can cause this disease as well.

• Different medications such as Neurontin 200mg, TID, Baclofen 10mg, and Ritalin are prescribed to the patient.

Incidence and Economic Effects

• Throughout the years of 1993-2006:• 288,454 patients admitted to hospital for diagnosis of Multiple

Sclerosis.• Average cost ranges from 7,965 to 20,076 dollars for each

patient.• A significant change in home health from 8.6% to 14.9%.• Average staying in the hospital lessens from 6.9 days to 4.9 days.• As an outcome of this disease Nursing homes & Rehabilitation

Centers increased from 8.3% to 22.6%• In the year of 2006 Multiple Sclerosis was the major non-

traumatic neurological handicap among the young people in USA and in numbers it was 350,000 individuals.

Presentation of MS

Most common symptoms of MS are:• Numbness• Fatigue• Coordination & balancing

problems• Malfunctioning of bowel and

bladder• Severe pain• Sexual malfunction• Cognitive dysfunction• Depression• Emotional changes

Some less common symptoms• Problems in swallowing• Speech disorder• Loss of hearing• Headache• Tremor• Seizures• Itching• Breathing and respiratory

complication

Socio-cultural Needs

Healthy way of living should be the goal for the people who are affected with multiple sclerosis.

• Developing healthy relationship• Make a chase for achieving career and educational

goal.• Maintain a healthy lifestyle during the periods of

provocation.• Enlisting support• Recall of spiritual needs in your life.• Planning for the future.

Multiple Sclerosis Therapies

Conventional Therapies:• Beta-interferon therapy minimize exacerbations• Steroids: Reduce inflammation• Anticonvulsants: Relieves a person from nerve pain• Immunosuppressant’s: Dispirit the immune system• Muscle Relaxants: It’s a great aid in controlling

muscle spasm• Parasympathetic: Almost eliminate bladder

complications.

Multiple Sclerosis Therapies

Complementary and Alternative Therapies:• Choose fiber rich and low fat diet.• Make an habit of regular exercise• Avoid stress• Acupuncture is helpful against a verities of

problems• Concentrate on vitamins.

Potential Learning NeedsDetermine:• Patient’s readiness to learn: Consider the cues that the patient is

inquiring regarding MS when he is in the worst stage of symptoms. Keep in mind that different individual is in different stages of readiness.

• Preferred style of learning: Learning can take place by audio, video or touch. All of these methods have their own benefits and limitations.

• Never think that the topics you are giving emphasis will be of the same priority to the patient. He or she might have different choices. Ask patients what topics they would like to begin with.

• Language understanding problem, impaired memory, physical disabilities, lack of knowledge on that particular field, impaired hearing or sight could be barriers of learning.

Teaching Strategies

• Various learning or teaching strategies can be used.

• Direct instruction, written instruction, internet and other technology based methods, group training are the significant ones.

• Integration of different activities which include specific personal instruction and other personal involvement can be the most effective learning strategy.

More Teaching Strategies

Patients get information as well as medical care from several clinical settings:

• This process generally starts in a physician’s chamber. Consistency of information is necessary.

• Information is offered by healthcare professionals.

• Multiple sclerosis has several symptoms and they are actually unpredictable.

References

Engelke, Z. (2011). Patient Education: Teaching the Patient with Multiple Sclerosis. CINAHL Nursing Guide. Retrieved from EBSCOhost.

Lad, S.P., Chapman, C.H., Vaninetti, M., Steinman, L., Green, A. & Boakye, M. (2010, August). Socioeconomic Trends in Hospitalization for Multiple Sclerosis. Neuroepidemiology, 35(2), 93.-99. Electronic Publication 2010, June 15, EBSCOhost.

National Multiple Sclerosis Society. (2011). Complementary & Alternative Medicine. Retrieved fromhttp://www.nationalmssociety.org/index.aspx

Neighbors, M. & Tannehill-Jones, R. (2006). Human Diseases (2nd ed.). Clifton Park, NY: Thomas-Delmar Learning.

Williams, L. S. & Hopper, P. D. (2007). Understanding medical surgical nursing (3rd ed.). Philadelphia, PA: F. A. Davis.