Patient’s Health Condition
Multiple sclerosis defined as the disease of central nervous system that affects the coordination of the body. The signs and symptoms including prolonged double vision along with tremor, sensations of electric shock as observed in this case study. This case study presents the health condition of the patient, Mr Dinh Nguyen who is 83 years old and is a widower. The patient showed a history of Multiple Sclerosis (MS) which occurred six years ago. He was also diagnosed with osteoarthritis about four years ago. The patient showed some signs and symptoms which occurred during specific movements like neck movements, bowel problems and function of the bladder (Cao et al., 2015). The purpose of the study is to focus on two nursing theory, Miller’s theory of functional consequences and clinical reasoning that aid nurses in clinical decision making in this situation and provide care. Therefore, this paper primarily will focus on the first four steps of clinical reasoning cycle where care priorities of the patient would be identified and this would be supported by miller’s theory. Moreover, according to the top priorities the actions taken by nurses will be discussed.
In this case study, the patient was experiencing from all the health issues of multiple sclerosis (MS). He was experiencing blurred vision along with presence of numbness in the facial area as well as electric shock when he tries during movement of head and neck. Electric shock experienced while the movement of the head and neck which runs down to the lower portion of his body and hinders his normal movement (mobility) and gait. This affecting his daily activities such as dressing, showering, cooking becomes difficult for him to perform. He is quite apprehensive about the loss of mobility since he stays alone after the death of his wife. The patient also suffered urinary incontinence. All the symptoms together indicate the reoccurrence of multiple sclerosis.
Multiple sclerosis is a potential disease affecting the nervous system that disables the central nervous system of individuals. The protective sheath of the brain is affected severely since the immune cells of the individuals diminish the myelin sheath of brain (Lublin et al., 2015). Eventually, miscommunication observed in rest of the anatomy. Multiple sclerosis is an immune disease that directly does not affect joints. However, individuals experience severe inflammation of because of the degradation of cartilages. Blurred vision in multiple sclerosis may consider as the result of neuritis in the optic nerves due to inflammation. The lesion that is found in the pathways of nerve cells that control optical movements in patients. The individuals also experience blurred vision (Toosy, Mason & Miller, 2014).Numbness considered as a common symptom of multiple sclerosis first experienced by the patient. Since immune system of the individual attacks the protecting sheath of the brain, the patient lost minimum sensation of face and experience numbness in rest of the organ (Dendrou, Fugger &Friese, 2015). The immune system of individuals also affects the occipital nerve and subsequently, patient suffers from electric shock experiencing in their head and neck occasionally travelled down to their neck and legs which in turn hinders their mobility and gait. Urine continence also observed since he had weak bladder because of the disease few pieces of evidence also reported that the combination of genetic susceptibility and other environmental factors that leads to the development of this disease (Eroglu et al., 2016). The risk factors of the disease is not clear but recent researches suggested that deficiency of vitamin D, smoking habits of individuals along with Epstein Barr virus infections are also able to make an impact on the occurrence of multiple sclerosis (Veroni et al., 2015). As observed in this case study, he was facing difficulties while performing any daily activities. As he was not able to shower properly, he might develop inappropriate skin hygiene. He is also having urine incontinence. It is therefore becoming hard for him to cope up with situation. Moreover, after the death of his wife he lived in separation and experienced isolation due to the hindrance in physical movement. Subsequently, he might suffer from severe depression (Moss-Marris et al., 2016). Financial problems are also observed since he did not have enough money required for facilitate the standard of life. Therefore, he became apprehensive that how he will be able to face the uncertainty of his future. All of the issues will give rise to the situation where he will lead the life of poor quality and will experience depression, hindrance of movement because of self-care deficit.
Signs and Symptoms of Multiple Sclerosis
From the above discussion, it is evident that three important nursing priorities need to be care by the nursing professionals. The first one is to assist him in developing the physical stability such as movement and assessment of diverse risk factors that leads to sudden fall. (Hunter, 2016). The patient was suffering from mobility issues due to the movement hindrance. Hence, the issues should be assessed by health care provider in order to prevent fall. Second, he has lost his normal abilities of performing daily activities of life such as dressing, showering, cooking. This will further affect his quality of life such development of skin irritation and inappropriate hygiene. Third, he was in isolation for long period of time after the death of wife. He is gradually losing encouragement and stability in performing different daily activities of his life. Therefore, self care deficit should be taken into account during interventions and care should be given by nurses accordingly.
Miller had developed a functional consequences theory for nurses where he stated that older adults experience functional consequences because of diverse age related issues which further will give rise to other health complexes. Therefore, lack of the proper interventions in adults will give rise to negative consequences which if not taken care might result in poor quality life and different physical disabilities (Synnot et al., 2016). Therefore, this theory helps the nursing professionals to identify the factor that causes negative consequences and thereby it will help in providing interventions that will improve the quality of life ((Bove&Chitnis, 2014). This theory therefore supports the nursing professionals, which in turn helps the old people to experience satisfaction. Therefore, nurses should monitor changes that are influencing the health conditions of the patients are because of the aging as well as diseases condition (Miller, 2018).
It is crucial that nurses should identify the most important concerns such as the loss of the ability of the movement in the patient is because of disorder due to aging. According to this theory, it is identified that patient lost his mobility due to the exacerbation of the disorder of Multiple sclerosis (MS). Movement of the normal individuals mainly takes place as result of the coordinated as well as efficient muscle contraction (Dendrou, Fugger &Friese, 2015). The coordination of the muscle mainly takes place because of the integrated nervous systems, brain, skeletal and spinal cord functions. Along with it, cerebellum process the information that helps in allowing the more fine-scale, precise movements (Nilsagård et al., 2015). However, in case of the Multiple sclerosis (MS), messages are not transmitted properly and brain lost all the coordination. Loss of mobility is mainly results from the progressive degradation of the myelin since immune cells attack the protective myelin sheath (Calabrese et al., 2015). This leads to the disruption of the transmission of the nerve signals and muscles lack the signal that indicates the contractions (Marinelli et al., 2015). These affect the joint reflex in patient. Hence, according to Miller’s functional consequences theory the nursing) professionals after indentifying that the loss of mobility is due to disorder should take effective steps to ensure that the old patients are able to live standard life (Miller, 2018).
Theories Supporting Clinical Decision Making
The prime goal of nursing in this situation would be managing the various symptoms of disease, shortening of the exacerbations and to ensure the slowing of the rapid progression of the disorder. The main goals would be managing issues he was facing such as mobility so that he can maintain a stable gait, perform his daily activities, can interact with friends and families and overcome the feeling of isolation.
Referring to the above case study, one of the crucial interventions that nurses should also conduct is that appointing physiotherapist along with other medications that will help him to gain his normal life. Exercise would be done by professionals that will help to build the strength and balance of the patient as well as maintain coordination with other parts of the body. The occupational therapists should be appointed who will help the patient to gain the energy of life and will help him to cope up with stress and will encourage to involve in daily activity (Ashley & Stamp, 2014).The fall risk management such as attaching bed rails from his house, bathroom bars, proper lighting in his room should be done (Levett-Jones, 2013). Mobility assessment tools should be used for monitoring his stability and movement. This will help him in development of mobility and will prevent the chances of sudden fall.
The identification of issues such as impairment of performing the daily activities and self acre deficit considered as the priorities of nurses in order to give patient centric care. In this case study, since patient lived in isolation for longer period of time, he experiences depression. Therefore, to manage this problem, as a caregiver, I will address the issues of patient related to the disease that affects the life. I will understand the risk factors that lead to progression of disease. Besides, I will provide the relevant information of disease to the patient and explain to him the ways of managing his health problems. I will provide patients the proper medications and include appropriate diet and lifestyle maintenance of the patient so that the physical movement of patient and vision will be able to be restored. I will make efforts to encourage the patient to implement self-care management in order to perform normal activities and enhance the ability to cope up with problem. I will also ensure the arrangement of the accurate sessions of therapy in addition to the motivational speech session that will elevate the quality of life.
Nursing Priorities
From the above analysis of this case study, patient has been suffering from the issues of movement due to multiple sclerosis. His health conditions worsen due to the fact that he lived in isolation after the heath of his wife. Therefore, with the help of Millar’s theory and clinical reasoning cycle it can be concluded that issues of mobility he was experiencing mainly due to multiple sclerosis. The goals of nurses in this situation were managing his stability issues and managing the risk factors of disease. Appointing physiotherapist will help him to live the standard life. Exercise with the help of the professionals will help him to gain the strength and stable movements. The occupational therapists should be appointed who will help the patient to gain the energy of life and will help him to cope up with stress and will encourage involving in daily activity. All of these activities will help him to cope up with his current situation. Moreover, participating in social activities such as motivational speech, motivational therapy and other physical and mental therapies will help him to cope up with his current situation.
References:
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