Clinical Reasoning Cycle for Multiple Sclerosis Patient

Introduction
Clinical reasoning cycle consists of some steps which are necessary in
identifying the proper nursing care strategies after a thorough assessment of any
patients’ health related issues (Levett-Jones, 2013). It is also helpful in making any
decision regarding the health condition and treatment procedure of the patient. The
clinical reasoning cycle is very much effective in nursing practice to provide care for
the patients (Hunter, 2016). In this paper, the case study of an elderly patient will be
considered who is suffering from Multiple Sclerosis. According the condition and
background of the patient, information will be collected. After that the paper will
describe how the information will be processed and the major problems will be
identified. Considering the identified problems, goals will be established and
according to that some actions will also be taken. The evaluation and reflection after
the action will also be illustrated in the paper. Finally, the paper will conclude with the
future requirements for the patient to improve his health condition.
Part A
Considering the patient’s case
The name of the client is Mr. Dinh Nguyen and he is 83 years old widower.
Six years ago, he was diagnosed with Multiple Sclerosis (MS). Even, four years back
he was also diagnosed with osteoarthritis which came under control following some
medication process. His wife died twelve months ago and since then Nguyen is living
alone in his two storey home with ongoing grief as well as increased isolation. For
not having any child, Nguyen has no immediate family and he is living an
independent life too. Recently he is experience some health declination and he feels
a pain similar to “electric shock” when he moves his body while doing any action and
it is affecting his movement and gait severely. Nguyen is also experiencing blurred
vision. He lives in a two storey house and if this continues then the risk of falling will
be higher and he may become the victim of serious accident. His small and
independent income only covers his required expenses. However, he tries to go out
in holidays once in a year, but due to his altered mobility, this year he could not.
Recently he is also experiencing some urinary incontinence and he wonders if these
difficulties continue to grow then how he will face all the uncertainties in future being
alone.

Collecting information
Since the death of his wife one year ago, Mr. Nguyen is living alone as they
do not have any child. However, he has a brother, Bao who lives with his own family.
Although, very close to Dinh’s house but Dinh do not want them to be bothered by
involving in his personal matter. Due to the recent death of his wife he is undergoing
some grief and he lives a completely isolated life from his extended family. However,
he was diagnosed with Multiple Sclerosis six years back but, from some days, when
he is moving his head and neck, he is experiencing an “electric shock” type of felling
which is travelling down from his back and into the legs. This is affecting his daily
activities like cooking, showering and dressing. Particularly at the time of bending
down to tie shoe laces he faces the extreme difficulty due to this feeling. Also he is
experiencing a visual disturbance in the form of blurred vision and numbness in his
face. Even, some episodes of urinary incontinence has also been found as a
symptom of MS. For his osteoarthritis, which is now under control he uses Panadol
Osteo 4/24 Oral prn, he also uses Teriflunomide 14mg Oral daily to control his
bladder function and all other symptoms of MS. During the exacerbation of the
disease, he uses Prednisolone 25mg oral BD.
Processing information
 Multiple sclerosis- It is a potentially disabling disease which affects the central
nervous system including the brain as well as the spinal cord of a human
body. In creates the communication problem between the brain and the other
parts of the body. The signs and symptoms of this disease vary according to
the amount of nerve damage (Filippi et al., 2017). In this case the patient is
having the feeling of electric sensation travelling down from the back to the
leg. This disease can increase the risk of falling and cause paralysis in long
term among the patients. Some environmental factors such as depression can
also be responsible for the extremity of the disease (Thompson et al., 2017).
 Vision disturbance- It is related to MS and this problem comes and goes
frequently. Different types of visual disturbances can come out as a symptom
of MS among the patients and in this case Nguyen is affected by blurred
vision which is termed as optic neuritis as an effect of Multiple Sclerosis

(Hauser et al., 2017). The condition stays up to two weeks and then begins to
improve gradually.
 Urinary incontinence- This happens as the brain fails to transmit the signal on
when the bladder is full due to the nervous dysfunction (Dendrou, Fugger &
Friese, 2015). A patient of bladder incontinence may experience difficulty in
holding urine in the bladder and feeling the bladder is not emptying completely
(Cotterill et al., 2016). During coughing and sneezing the urine may come out
accidentally.
Identifying the problems or issues
Synthesizing all the information that has been collected and processed, three
main problems of the patient has been identified as the major issues. Nguyen was
diagnosed with MS six years back, and it is the main problem which is creating
several issues. All the issues are vital and they are as follows.
1. Lhermitte’s sign- It is associated with MS and creates uncomfortable
sensation among the patients which affects the normal activities as well as
movements. If nerves are no longer coated with myelin as a consequence of
MS as it destroys myelin, then these damaged nerves responds all the
movements of the neck and as a result create sensation and “electric shock”
type feeling (Raza, Behzadi, Blumenfeld, Girardi & Prince, 2018). Nguyen is
experiencing the feeling while cooking, showering, dressing and mostly while
making shoe laces, bending down. This problem is highly important as the
patient lives alone in a two storey house so difficulty in movement can
increase fall risk and can ruin his independency too.
2. Optic neuritis- This is a type of visual disturbance that is occurred as a result
of MS and it blurs the vision of the patient. The symptom develops when the
MS begins to break down the coating surrounding the optic nerve of the
patient. However, this disturbance goes away within few weeks but it also
comes back again (Montalban et al., 2017). The condition worsens when the
MS grows and may lead to permanent blindness in some cases also. Almost
70% patients of MS have experience optic neuritis or blurred vision problem
(Balcer, Miller, Reingold & Cohen, 2014). In case of Nguyen, this can create
accident as he lives alone. It will affect his daily activity too.