Clinical Reasoning Cycle for Multiple Sclerosis Patient

This paper discusses the clinical reasoning cycle for a patient with multiple sclerosis, including considerations for patient care, information collection and diagnosis, and self-care management interventions.

Running head: NURSING ASSIGNMENT
Nursing assignment
Name of the Student:
Name of the University:
Author Note:

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Table of Contents
INTRODUCTION:..........................................................................................................................2
DISCUSSION:.................................................................................................................................2
PART A:......................................................................................................................................2
1. CONSIDERATION OF PATIENT:....................................................................................2
2. COLLECTION OF INFORMATION:................................................................................3
3. PROCESS OF INFORMATION:........................................................................................4
4. IDENTIFIED ISSUES AND DIAGNOSIS:.......................................................................5
PART B:......................................................................................................................................6
5. ESTABLISHMENT OF GOAL:.........................................................................................6
2. TAKE ACTION:.................................................................................................................6
3. EVALUATE OUTCOME:..................................................................................................7
CONCLUSION:..............................................................................................................................8

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INTRODUCTION:
Multiple sclerosis is defined as the potential disease of the nervous system that disables
the brain and spine of the individuals. In this disease myelin sheath of the brain significantly
affected since the immune system attacked this protective sheath (Lublin et al., 2015).
Eventually, disruption of communication between brain and body observed.Further progress of
the disease can cause permanent damage to nerve cells of central nervousness (Douvaras et al.,
2014). Sign and symptoms of illness include prolonged double vision, Tremor, Electric-shock
sensations that occur with specific neck movements, problems with bowel and bladder function.
However, the signs and symptoms differ depending on affected nerve areas of individuals and
the health condition of the individuals. In most of the scenario, individuals experience new signs
and symptoms over the week or years. In this case study, Mr. Dinah Nguyen, an 83 old man who
was diagnosed with multiple sclerosis six years ago and four years ago he was diagnosed with
Osteoarthritis. Recently, he experienced few health complications. Therefore, this paper will
illustrate the clinical reasoning cycle of disease in the following paragraphs.
DISCUSSION:
PART A:
1. CONSIDERATION OF PATIENT:
In this case study, Mr. Dinah Nguyen, an 83 old man who was diagnosed with multiple
sclerosis six years ago. Recently, he experienced few health complications such as blurred
vision, numbness in face, electric shock during the movement of the head and neck which further

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transmitted to legs and back and restrict his normal movement. Subsequently, the daily activities
of the patient such as dressing, showering, cooking become difficult for him to perform. He also
experienced the events of urinary incontinence, and these symptoms together indicate the
reoccurrence of multiple sclerosis. Advanced investigations indicated that generally young
adult’s experience (age in between 20yearss to 40 years) multiple sclerosis (Kavak et al., 2015).
However, older individuals, especially older male can develop multiple sclerosis as observed in
this case study and susceptibility is higher than younger individuals. The prime reason behind
this susceptibility is that with age the functional efficiency of the central nervous system
decreases exponentially and immune system become weak (Dendrou, Fugger &Friese, 2015).
Few studies also suggested that few hormones have massive impact in developing the disease
(Berkovich et al., 2017). In the case study, Mr. Dinah Nguyen lived alone after the death of wife
and this isolation worsen the health conditions. Therefore, the health conditions of individuals
also act as crucial player in reoccurrence of the disease.
2. COLLECTION OF INFORMATION:
In this case study, Mr Dinah Nguyen was diagnosed with multiple sclerosis six years ago,
and recently he was experiencing few health complications which altogether indicates the
prevalence of multiple schelarosis. However, he was diagnosed with osteoarthritis four years
ago. He is currently prescribed with teriflunomide, panadolosteo and prednisolon. Multiple
sclerosis is an immune disease that does not affect the joints of individuals directly. However, in
both cases, individuals experience inflammation of knees due to degeneration of cartilages
(Marrie et al., 2015). Therefore, recent evidence suggested that multiple sclerosis and
osteoarthritis may be linked to each other. Older investigation suggests that the combination of

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genetic susceptibility and environmental factors together give rise to multiple sclerosis. The risk
factors of this disease are not clear but investigations enlisted few risk factors such as deficiency
of vitamin D, smoking habits, Epstein Barr virus infections that are able to influence the
occurrence of multiple sclerosis (BelbasisBellou,Evangelou,Ioannidis&Tzoulaki, 2015). These
risk factors, especially vitamin D deficiency plays a crucial part in the wide range of the disease
as observed in this case study. Moreover, Mr Dinah Nguyen lived alone in isolation after the
death of his wife which had huge psychological impact on the health condition on him.
3. PROCESS OF INFORMATION:
In this case study, Mr. Dinah Nguyen was diagnosed with multiple sclerosis six years ago
and osteoarthritis four years ago. Recently he experienced symptoms such as blurred vision,
numbness in face, electric shock during the movement of the head and neck which further
transmitted to legs and back and restrict his normal movement. Abnormal visualization in
multiple sclerosis may rise as a result of optic neuritis where inflammation of the optic nerve
observed in the patient (Iester et al., 2016). Lesion found in the nerve pathways that control eye
movements in patients and patient lost visual conditions and subsequently experiences blurred
vision. Numbness is considered as common symptoms of multiple sclerosis .Numbness is the
first symptom experienced by patients with this disease. In multiple sclerosis, the immune
system attacks the protecting sheath of brain and brain eventually lost all the regular coordination
with rest of the body. Subsequently, the patient lost all the sensation and experience numbness in
the face and other parts of the body. Numbness can be temporary depending on the current health
condition but experiencing lack of sensation for a long time can be a sign of axonal damage
(Arima et al., 2015). The patient also experienced electric shock during the movement of head
and neck which is a symptom of occipital neuralgia that associated with multiple sclerosis. The

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occipital nerve runs from the top of the spinal cord and up to the neck and scalp. In multiple
sclerosis, the immune system also damages the occipital nerve and individuals experience an
electric shock in their head and neck that travelled down to their neck and legs hindering their
movement as observed in this case study(Kissoon et at., 2018). He also experienced urine
continence as he had a weak bladder due to the disease. Moreover, since he lived in isolation, he
experienced depression which worsened his health condition.
4. IDENTIFIED ISSUES AND DIAGNOSIS:
In this case study, Mr Dinah Nguyen was suffering significant issues such as multiple
sclerosis, osteoarthritis and most importantly self-care deficit. These issues are related to each
other that affect the health condition of him. In such cases, the top priority of reliving the
neurological deficit and shorten the exacerbations of disease to improve the quality of life. In
such cases, histories of the patient should be collected. Moreover, evidence of the damage in the
central nervous systems such as a brain, spinal cord and optic nerves should be gathered by
performing different tests for mental and emotional language functions, walking coordination
and vision. However, in a majority of the cases, Magnetic resonance imaging with combination
with the initial blood test is the test of choice for evaluating the abnormal tissues in the brain and
along with a presence of water in mind. Analysis of cerebrospinal fluid also considered as useful
diagnosis method (Thompson et al., 2017). Cerebrospinal fluid is a clear colorless fluid that
absorbs the shock of the central nervous system and cushions the brain. Presence of specific
proteins indicates the abnormal immune response in central nervous system Thompson et al.,
2017). Moreover, for coping with the stress situation effective communication should be made
with the patient to understand the core of the problem.

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PART B:
5. ESTABLISHMENT OF GOAL:
Considering the top priority of the nurse to cure the patient for improving the lifestyle of
the patient, the issues are multiple sclerosis and self-care deficit. According to the care plan of
nursing, a goal is needed to establish them to promote self-care inpatient. Here, the goal that has
been set for managing the patient is to encourage the self-management of the patient, and this
can be achieved by tracking the recovery in patient time to time (Levett-Jones, Bowen&Morris
2015). Moreover, monitoring the medicine uptake is part of accomplishing goals. The
consumption of PanadolOsteo 4/24 Oral prn for eight days, Teriflunomide 14mg for daily,
Prednisolone 25mg during exerbaration should be monitored. The goal of recovery can be
achieved fast if some therapy session arranged for the mental stability of the patient (Hunter ,
2016).
2. TAKE ACTION:
Self-care and management of disease require the management of clinical symptoms
showed by patients. in order to overcome such disease, proper lifestyle should be followed such
as proper diet, adequate sleep and adequate exercise for recovery. Action should be taken to
maintain the good mental health. The situation that induces the depression, grief, anger and
anxiety should be should be handled properly for the improvement of the patient (Synnot et al.,
2016). Interventions for personal care of the patient should be taken that includes empathy
provided by medical practitioner, cognitive behavioral therapy, motivational therapy and speech
(Levett-Jones, 2013).

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3. EVALUATE OUTCOME:
Self-care management adopted as a part of the interventions of nurses helps the patient
with multiple sclerosis to improve the mental health. These interventions help to decrease the
anxiety and depression in patient and patient will be more careful about personal hygiene.
Moreover, self-care management also helps the patient to take medicines properly from time to
time. There was a barrier related to interventions of the patient with chronic depression and
multiple sclerosis. Self-management help to overcome this barrier and role of the caregiver
should be taken into consideration to facilitate the quality of life (Synnot et al., 2016).
4. REFLECTION:
The identification of self-care deficit is defined as the impairment of performing the daily
activities such as bathing, cooking, dressing and feeding. This subsequently leads to the poor
hygiene. Therefore, in order to manage this problem, I will identify the area of the problem in the
life of a patient that affected the lifestyle. I will understand the risk factors and analyses the
further problem in that can worsen the present situation. Besides, I will provide the knowledge to
the patient about the disease and proper lifestyle to reduce the disease so that patient can meet
these criteria and overcome the difficulties of coping up with the problem. I will administrate the
medications and incorporate proper diet in a lifestyle of the patient that the walking movement
and vision of the patient will restore. I will request the patient to perform the self-care for
improving the lifestyle and enhance the capacity to overcome the problem. I will arrange the
proper therapy session and motivational speech session to enhance the standard of life.

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CONCLUSION:
From the above analysis of the case study, it can be concluded that multiple sclerosis is
an disease of immune system that affects the central nervous system of individuals and brain lost
proper communication with other parts of the body. The pathophysiology, sign and symptoms of
this disease vary from person to person. The risk factors for this disease also identified in this
case study that can further enhance the reoccurrence of the disease. Therefore, this paper helped
to define the priorities of the nursing care plans that are needed to manage the patients who have
multiple sclerosis. MRI, analysis of cerebrospinal fluid considered as the diagnosed method for
understanding disease. Here top priority of the nurse identified for self-management of the
patient is a self-care deficit. To overcome the disease, self-care management interventions are
helpful in the patient who lived in isolation for the more extended period and had experienced
depression.

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