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Nursing care principles for multiple sclerosis
  • 6

  • Course Code: NRSG265
  • University: ACU
  • Country: Australia

Task 

Students will create an online education resource (website) for a chosen disease.
You will choose ONE of the four provided scenarios below and create an online educational resource package (a website)
Your target audience are registered nurses (graduates) or enrolled nurses who need an education resource to help plan the care for their patients.

The website must include the following sections:

1.    Justification and epidemiology:
•    Identify the chosen disease. What is your rationale for choosing this disease? Provide an overview of epidemiological data for the chosen disease within the Australian context.

2.    Pathophysiology and pharmacology (video):
•    You are required to create and upload to the website a short video (6-7 minutes maximum length) of yourself “teaching” your target audience about the disease pathophysiology and related pharmacology.
•    This video needs to include:
i.    A comprehensive discussion of the pathophysiology of the chosen disease
ii.    Identifications of one (1) drug commonly used to manage the chosen disease. You need to identify the drug class, describe the mechanism of action, indications and relevant considerations for the chosen drug, with reference to the patient. This needs to be linked back to the pathophysiological changes of the disease.

3.    Impact of chronic disease:
•    Identify and discuss the impact of the chosen chronic disease on the patient.

4.    Long term management and health promotion strategies:
•    Identify long term management strategies to promote health and independence for the patient with the chosen chronic disease. These should be linked to the identified factors impacting the patient in the previous section.

5.    Nursing care plan for an acute exacerbation (infographic):
•    You are required to develop a nursing care plan that identifies two (2) acute issues, goals and interventions to manage the issues.

6.    Justification of nursing care:
•    You will provide your discussion and justification for the identified issues and interventions outlined in your nursing care plan.

7.    References

Scenarios:


1.    A 30-year-old female of Vietnamese background, with a strong family history of thyroid disease. Recently diagnosed with Graves' disease.

2.    A 58-year-old female of Italian background with history of hypertension, type 2 diabetes mellitus, diagnosed with heart failure with preserved ejection fraction (HFpEF).

3.    A 69-year-old male of Australian background with a history of hypertension and is a current smoker (30 years), diagnosed with aortic stenosis.

4.    A 35-year-old female of Irish background with a family history of multiple sclerosis (father). Newly diagnosed with multiple sclerosis.
 

1 Justification and epidemiology

Multiple Sclerosis (MS) is an autoimmune, neurodegenerative disorder characterized by chronic inflammation, demyelination, and axonal damage within the central nervous system. It manifests variably, presenting symptoms ranging from fatigue and numbness to motor and cognitive impairments (Oh et al., 2018).

The decision to focus on MS stems from its notable prevalence within specific demographics, including the age group of our exemplar patient, and the heightened risk associated with a familial history, as seen in her father's diagnosis (McGinley et al., 2021).

Within the Australian context, epidemiological data provides compelling insights. Approximately 25,600 individuals in Australia are diagnosed with MS, with an alarming 10 new cases identified each week (Campbell et al., 2020).

Distinctively, the age group most commonly diagnosed falls between 20 and 40 years, underscoring its impact on the younger, active population. Furthermore, there exists a discernible gender disparity: women are three times more likely to be diagnosed than men (Ahmad et al., 2020).

While ethnicity plays a role, with those of Northern European descent, such as our Irish-background patient, demonstrating a higher susceptibility, it remains essential to note that MS can affect individuals irrespective of racial or ethnic backgrounds (Marck et al., 2021). Collectively, these factors underscore the imperative for healthcare professionals to be adept in both understanding and managing this complex disease.

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2 Impact of Chronic Disease

The reverberations of Multiple Sclerosis (MS) extend far beyond its physiological manifestations, deeply embedding itself into multiple facets of an individual's life. Physically, the patient grapples with debilitating symptoms, with mobility issues and persistent pain being paramount. These challenges necessitate frequent medical interventions, which, while indispensable, often introduce additional physical and emotional burdens due to side effects or procedural discomforts (McGinley et al., 2021).

Psychologically, the relentless nature of MS invariably precipitates a myriad of mental health challenges. Patients often confront feelings of anxiety, depression, and uncertainty about their future. The visible symptoms and the unpredictable nature of flare-ups can tarnish one's self-image and erode self-worth, further exacerbating emotional distress.

Socially, the disease reshapes relationships and roles. Activities once taken for granted might become insurmountable challenges, leading to potential isolation (Lublin et al., 2022). Furthermore, societal misconceptions about MS may foster undue stigma, further alienating the affected individual.

Economically, the ramifications are equally profound. The cumulative medical expenses—ranging from consultations to medications and therapies—can strain financial resources. Additionally, the physical and cognitive impediments wrought by MS often lead to reduced work capacity or even premature job cessation, curtailing the individual's earning potential and further exacerbating financial stresses (Rodríguez Murúa et al., 2022). Collectively, these multifaceted impacts underscore the pervasive nature of MS in an individual's life.

3 Script for Video

Introduction

•    Pathophysiology: Fundamental to comprehending the underlying mechanisms driving disease progression in Multiple Sclerosis (MS).
•    Pharmacology: Central to effective management, tailoring therapeutic interventions, and optimizing patient outcomes.
•    Interrelation: Understanding the synergy between pathophysiology and pharmacology facilitates improved patient care and long-term well-being.

Diving deeper into the realm of Multiple Sclerosis (MS) care, the significance of grasping both pathophysiology and pharmacology cannot be overstated. A profound understanding of the pathophysiological changes offers clinicians invaluable insights into the intricate mechanisms at play, elucidating the disease's progression and manifestations.

Concurrently, a robust comprehension of pharmacology, including drug mechanisms and potential interactions, empowers healthcare professionals to curate tailored therapeutic strategies, bolstering efficacy and mitigating adverse effects.

In essence, marrying knowledge of both domains—pathophysiology and pharmacology—serves as a linchpin in delivering holistic, evidence-based, and patient-centric care, optimizing both immediate interventions and long-term outcomes for those grappling with MS.

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Pathophysiology of MS

•    Definition: An autoimmune, neurodegenerative disorder targeting the central nervous system.
•    Cellular Impact: Chronic inflammation, demyelination, and axonal damage.
•    Nervous System: Disruption of nerve impulses leading to varied symptoms.
•    Progression: Multiple types, each with distinct patterns and severities.

Multiple Sclerosis (MS) is aptly defined as an autoimmune disorder where the body's immune system erroneously attacks the protective sheath—myelin—surrounding nerve fibers in the central nervous system. At a cellular and molecular level, this assault results in chronic inflammation, leading to the degeneration of myelin and the nerve fibers themselves.

This demyelination disrupts the seamless transmission of nerve impulses, manifesting in a spectrum of symptoms that can affect motor, sensory, and cognitive functions. MS is not monolithic in its progression; it presents in varied forms.

Some patients experience relapsing-remitting MS, marked by acute episodes followed by periods of remission, while others may grapple with primary-progressive MS, characterized by a steady worsening of neurologic function. Understanding these intricacies is pivotal for clinicians to provide tailored care and interventions.

Symptoms and Clinical Manifestations

•    Common Symptoms: Fatigue, numbness, vision problems, muscle spasms, pain, and cognitive disturbances.
•    Pathophysiological Link: Symptoms arise from inflammation, demyelination, and axonal damage within the central nervous system.
•    Diverse Presentation: Symptom severity and type can vary widely between patients.

Delving into the clinical landscape of Multiple Sclerosis (MS), patients often present a myriad of symptoms, reflective of the regions of the central nervous system affected by the disease's pathophysiological processes.

Fatigue, for instance, is a pervasive complaint, attributable to the energy-intensive process of transmitting nerve signals through damaged areas. Vision problems, such as blurred or double vision, emerge due to inflammation of the optic nerve. Similarly, muscle spasms and pain stem from disrupted nerve signals to and from the brain.

Cognitive disturbances, while more subtle, underscore the disease's impact on brain function. It's pivotal to understand that these manifestations are not arbitrary; they are direct repercussions of the inflammatory and degenerative processes occurring at the cellular level, underscoring the intricate link between pathophysiology and clinical presentation.

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Pharmacological Management

•    Medication Role: Central pillar in managing and mitigating MS progression.
•    Diverse Options: Range from disease-modifying therapies to symptom-specific treatments.
•    Goal: Reduce inflammation, prevent relapses, and improve quality of life.

In the stormy path of Multiple Sclerosis (MS), pharmacological therapies play a crucial role, providing patients with a glimmer of hope. The goal of medications, especially disease-modifying treatments, is to slow down the course of multiple sclerosis (MS) by reducing the immune system's assault on the central nervous system.

Targeting the inflammatory and degenerative processes that underlie the pathophysiology of the illness, these medications act at the cellular level. In addition, there are several symptom-specific therapies that may be used to treat everything from exhaustion to muscular spasms.

The primary goal of pharmacological care is to greatly improve the patient's quality of life rather than only postpone the disease. Medication can help manage symptoms, prevent relapses, and reduce inflammation, which is a tribute to the progress made in MS therapy and offers hope for a better prognosis for patients.

Drug Choice: Interferon Beta-1a

•    Drug Class: Immunomodulatory drug.
•    Mechanism: Modulates immune system response, reduces inflammation.
•    Indications: Relapsing forms of MS.
•    Patient-Specific Considerations: Family history, age, and potential side effects.

An immunomodulatory medication called interferon beta-1a has become a mainstay in the fight against multiple sclerosis (MS). Its mode of action is centred on controlling the immune system's reaction, which successfully lessens the immune system's assault on the myelin sheath and lowers inflammation in the central nervous system.

Predominantly indicated for relapsing forms of MS, this drug seeks to reduce the frequency and severity of relapses, thereby decelerating the disease's progression. For our patient, given her familial predisposition and age, Interferon Beta-1a presents a promising therapeutic option.

However, as with all pharmacological interventions, it's imperative to weigh its benefits against potential side effects, ensuring the chosen drug aligns seamlessly with the patient's unique medical history and needs. This meticulous approach underscores the essence of patient-centred care in the realm of MS management.

Linking Drug Action to Pathophysiology

•    Action on Pathophysiology: Modulation of immune response, reduction in neuroinflammation.
•    Benefits: Decreased relapse rates, slowed disease progression.
•    Potential Side Effects: Flu-like symptoms, injection site reactions, liver function alterations.

The efficacy of Interferon Beta-1a in Multiple Sclerosis (MS) management is deeply intertwined with its ability to act upon the disease's underlying pathophysiological processes. By modulating the immune system's response, this drug directly targets the root cause of the myelin sheath's degradation.

This action results in reduced neuroinflammation, which is instrumental in decreasing the frequency of relapses and, by extension, slowing the disease's overall progression. The benefits, however, come hand in hand with potential adverse effects.

Commonly reported side effects include flu-like symptoms post-administration, reactions at the injection site, and alterations in liver function. It's imperative that clinicians maintain a vigilant eye on these potential ramifications, ensuring that the therapeutic benefits outweigh any adverse outcomes, all the while tailoring the treatment regimen to the individual nuances of each patient.

Conclusion

•    Foundational Knowledge: Grasping pathophysiology and pharmacology is pivotal.
•    Holistic Care: Informed decisions lead to tailored interventions.
•    Optimized Outcomes: A blend of understanding both domains ensures patient well-being and safety.

Navigating the multifaceted landscape of Multiple Sclerosis (MS) care necessitates a profound understanding of both pathophysiology and pharmacology. The intricate mechanisms underpinning MS's progression, when coupled with the therapeutic arsenal available, offer healthcare professionals a comprehensive toolkit to manage this complex disease.

Recognizing the cellular and molecular changes, and aligning them with evidence-based pharmacological interventions, ensures that care remains patient-centric, evidence-driven, and outcome-oriented. It's this synergy of knowledge, spanning the physiological intricacies of the disease and the pharmacodynamics and pharmacokinetics of therapeutic agents, that empowers nurses to deliver holistic care. In essence, a robust grasp of both these domains stands as a testament to the commitment of ensuring enhanced quality of life and optimized health outcomes for MS patients.

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4 Long-term management and health promotion strategies

In the journey of managing Multiple Sclerosis (MS), a holistic and multi-pronged approach is paramount. Medication management stands at the forefront, where adherence to prescribed regimens is crucial. Continuous monitoring for potential side effects ensures timely interventions, optimizing patient well-being and safety.

Physical therapy and rehabilitation play a pivotal role in fortifying the patient's functional capacities. Tailored exercises and routines aim to bolster mobility, mitigating the challenges posed by the disease (Benedict et al., 2020). Furthermore, these therapeutic interventions equip patients with strategies to adapt to and overcome physical limitations, fostering greater independence.

Mental health support remains integral, given the psychological ramifications of MS. Counseling or therapy provides avenues for emotional expression, while support groups offer solace in shared experiences, engendering a sense of community and understanding.

Lifestyle modifications further augment disease management. Dietary considerations, tailored to mitigate inflammation and bolster overall health, offer an additional layer of defense. Recognizing and avoiding exacerbation triggers becomes vital in reducing the frequency and severity of flare-ups (Filippi et al., 2019).

Lastly, vigilant health monitoring is indispensable. Regular medical check-ups ensure the disease's progression is meticulously tracked. In tandem, patients are encouraged to adopt self-monitoring techniques, empowering them to detect symptom fluctuations and seek timely interventions (Cree et al., 2021). Collectively, these strategies champion a proactive stance, enhancing quality of life amidst the challenges of MS.

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5 Nursing care plan for an acute exacerbation 

In the landscape of Multiple Sclerosis (MS) care, acute exacerbations present a formidable challenge, necessitating strategic and timely interventions. For Issue 1, characterized by severe muscle spasms, the root cause is identified as inflammation disrupting nerve impulses. The veracity of this symptom is evidenced by patient self-reports corroborated by clinical observations (Kuhlmann et al., 2023).

The objective, in this instance, is to curtail the frequency of these spasms by 50% within a 48-hour window. To achieve this, a two-fold intervention strategy is adopted: the administration of muscle relaxant medications and the implementation of targeted physical therapy techniques designed to alleviate muscle tension and promote relaxation (Kaufmann et al., 2022).

Conversely, Issue 2 delves into blurred vision, a consequence of inflammation targeting the optic nerve. This symptom's presence is confirmed through patient reports and substantiated by ophthalmologic assessments. The goal, ambitiously yet feasibly, is to enhance vision clarity over a span of 72 hours.

Interventions encompass not only the use of anti-inflammatory medications but also advocate for ample rest and a conscious effort to eschew activities that strain the eyes (Faissner et al., 2019). In synthesizing this care plan, the aim is to ensure that the interventions not only address the symptoms but also target the underlying pathophysiology, optimizing patient outcomes amidst the complexities of MS.

6 Justification of Nursing Care

Within the intricate tapestry of nursing care for Multiple Sclerosis (MS) patients, the rationale for issue identification and the subsequent interventions is grounded in evidence, patient-centeredness, and long-term well-being.

The impetus for acute exacerbation recognition lies in its potential to drastically alter the disease's trajectory. By discerning these episodes early, interventions can be more effective, potentially mitigating long-term complications (Magyari and Sorensen, 2020). The patient's historical data, coupled with their present clinical manifestations, act as pivotal guideposts in this identification process, ensuring a comprehensive understanding of their unique presentation.

In formulating goals, the SMART (Specific, Measurable, Achievable, Relevant, Time-bound) criteria provide a robust framework. This structured approach ensures that targets are not only precise but also rooted in realistic expectations. Aligning these goals with the patient's immediate requirements and future aspirations ensures that care remains patient-centric, fostering enhanced outcomes and satisfaction (Solomon et al., 2023).

The selection of interventions is steered by evidence-based practices, the gold standard in MS care. By tailoring these interventions to individual patient nuances, care becomes personalized, optimizing its efficacy. Paramount to this approach is the safety and comfort of the patient, ensuring that each intervention not only addresses the clinical symptomatology but also enhances the overall patient experience. Collectively, this nuanced approach to care justification underscores the commitment to holistic, evidence-driven, and patient-centric nursing (Fambiatos et al., 2020).

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References

Benedict, R. H., Amato, M. P., DeLuca, J., & Geurts, J. J. (2020). Cognitive impairment in multiple sclerosis: clinical management, MRI, and therapeutic avenues. The Lancet Neurology, 19(10), 860-871. https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(20)30277-5/fulltext 
Campbell, J.A., Simpson Jr, S., Ahmad, H., Taylor, B.V., van der Mei, I. and Palmer, A.J., 2020. Change in multiple sclerosis prevalence over time in Australia 2010–2017 utilising disease-modifying therapy prescription data. Multiple Sclerosis Journal, 26(11), pp.1315-1328. https://jamanetwork.com/journals/jama/article-abstract/2776694 
Cree, B. A., Arnold, D. L., Chataway, J., Chitnis, T., Fox, R. J., Ramajo, A. P., ... & Lassmann, H. (2021). Secondary progressive multiple sclerosis: new insights. Neurology, 97(8), 378-388. https://n.neurology.org/content/97/8/378.abstract 
Faissner, S., Plemel, J. R., Gold, R., & Yong, V. W. (2019). Progressive multiple sclerosis: from pathophysiology to therapeutic strategies. Nature reviews drug discovery, 18(12), 905-922. https://www.nature.com/articles/s41573-019-0035-2 
Filippi, M., Preziosa, P., Banwell, B. L., Barkhof, F., Ciccarelli, O., De Stefano, N., ... & Rocca, M. A. (2019). Assessment of lesions on magnetic resonance imaging in multiple sclerosis: practical guidelines. Brain, 142(7), 1858-1875. https://academic.oup.com/brain/article-abstract/142/7/1858/5519813 
https://jamanetwork.com/journals/jama/article-abstract/2776694
Kaufmann, M., Schaupp, A. L., Sun, R., Coscia, F., Dendrou, C. A., Cortes, A., ... & Fugger, L. (2022). Identification of early neurodegenerative pathways in progressive multiple sclerosis. Nature Neuroscience, 25(7), 944-955. https://www.nature.com/articles/s41593-022-01097-3 
Kuhlmann, T., Moccia, M., Coetzee, T., Cohen, J. A., Correale, J., Graves, J., ... & Waubant, E. (2023). Multiple sclerosis progression: time for a new mechanism-driven framework. The Lancet Neurology, 22(1), 78-88. https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(22)00289-7/fulltext 
Lublin, F. D., Häring, D. A., Ganjgahi, H., Ocampo, A., Hatami, F., Čuklina, J., ... & Bermel, R. A. (2022). How patients with multiple sclerosis acquire disability. Brain, 145(9), 3147-3161. https://academic.oup.com/brain/article-abstract/145/9/3147/6519354 
Magyari, M., & Sorensen, P. S. (2020). Comorbidity in multiple sclerosis. Frontiers in Neurology, 11, 851. https://www.frontiersin.org/articles/10.3389/fneur.2020.00851/full 
McGinley, M. P., Goldschmidt, C. H., & Rae-Grant, A. D. (2021). Diagnosis and treatment of multiple sclerosis: a review. Jama, 325(8), 765-779. https://jamanetwork.com/journals/jama/article-abstract/2776694 
McGinley, M. P., Goldschmidt, C. H., & Rae-Grant, A. D. (2021). Diagnosis and treatment of multiple sclerosis: a review. Jama, 325(8), 765-779. https://jamanetwork.com/journals/jama/article-abstract/2776694 
Oh, J., Vidal-Jordana, A., & Montalban, X. (2018). Multiple sclerosis: clinical aspects. Current opinion in neurology, 31(6), 752-759. https://journals.lww.com/co-neurology/Fulltext/2018/12000/Multiple_sclerosis__clinical_aspects.15.aspx 
Rodríguez Murúa, S., Farez, M. F., & Quintana, F. J. (2022). The immune response in multiple sclerosis. Annual Review of Pathology: Mechanisms of Disease, 17, 121-139. https://www.annualreviews.org/doi/abs/10.1146/annurev-pathol-052920-040318 
Solomon, A. J., Arrambide, G., Brownlee, W. J., Flanagan, E. P., Amato, M. P., Amezcua, L., ... & Cohen, J. A. (2023). Differential diagnosis of suspected multiple sclerosis: an updated consensus approach. The Lancet Neurology, 22(8), 750-768. https://www.thelancet.com/article/S1474-4422(23)00148-5/abstract 

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