Multiple Sclerosis

MS Case Study

D.V., a 32-year-old man, is being admitted to the medical floor from the neurology clinic with symptoms of multiple sclerosis (MS). D.V. has experienced increasing urinary frequency and urgency over the past 2 months. D.V. recently had two brief episodes of eye “fuzziness” associated with diplopia and flashes of brightness. He has noticed ascending numbness and weakness of the right arm with the inability to hold objects over the past few days. Now he reports rapidly progressing weakness in his legs along with blurred, patchy vision.

  1. MS is associated with scattered, patchy demyelination of the sheath around nerves in the brain and spinal cord. What does myelin do? What is demyelination?

 

  1. MS is characterized by remissions and exacerbations. What happens to the myelin during each of these phases?

 

  1. Is D.V. too young to get MS? What is the cause of MS?

 

  1. Overview the subjective and objective assessment data associated with MS. List the assessment data to those D.V. has.

 

  1. The neurologist orders an MRI scan of the brain and spine. What role does this test play in diagnosing MS?

 

  1. How will the neurologist determine whether D.V. has MS?

 

  1. What are the overall goals of collaborative care for a patient with MS?

 

  1. D.V. asks, “If this turns out to be MS, how will I be treated?” How would you respond?

 

  1. D.V. is started on interferon beta-1a (Avonex) 30 mcg intramuscularly each week. What teaching do you need to provide regarding interferon therapy?

 

  1. The neurologist also orders 500 mg methylprednisolone (Solu-Medrol) IV daily. What do you need to do to administer this medication safely? Select all that apply.

 

  1. Begin the infusion before 0900 each day
  • Reconstitute with 8 mL of benzyl alcohol
  1. Use the solution within 60 minutes of reconstitution
  • Administer a total dose of 8 mL of reconstituted solution
  • Deliver the dose over 30 minutes using IV pulse administration
  1. Because D.V. is experiencing urinary frequency and urgency, the neurologist orders oxybutynin. In addition to medication teaching, what will you teach him to do to assist in controlling urinary symptoms?

 

  1. When planning D.V.’s care, what goal is the most appropriate goal for the clinical problem of activity intolerance related to muscle weakness?
  2. “D.V. is free of trauma related to muscle weakness.”
  • “D.V. will maintain muscle strength in his arms and legs.”
  1. “D.V. can identify three factors that aggravate muscle weakness.”
  • “D.V. will participate in daily activities as desired without fatigue.”
  1. As part of your teaching plan, you want D.V. to be aware of situations or factors that are known to exacerbate symptoms. List 5.

 

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