Nursing Case Study: Multiple Sclerosis and Cardiovascular Disease

This nursing case study explores the impact of multiple sclerosis and cardiovascular disease on the body. It covers symptoms, treatment options, and care planning. The case study includes two scenarios, one on multiple sclerosis and the other on cardiovascular disease.

Running head: NURSING CASE STUDY
Nursing case study
Name of the student:
Name of the university:
Author note:

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Table of Contents
Case study 1:....................................................................................................................................3
Question 1:...................................................................................................................................3
Question 2:...................................................................................................................................3
Question 3:...................................................................................................................................3
Question 4:...................................................................................................................................4
Question 5:...................................................................................................................................4
Question 6:...................................................................................................................................5
Question 7:...................................................................................................................................5
Question 8:...................................................................................................................................6
Question 9:...................................................................................................................................6
Question 10:.................................................................................................................................7
Case study 2:....................................................................................................................................8
Question 1:...................................................................................................................................8
Question 2:...................................................................................................................................8
Question 3:...................................................................................................................................8
Question 4:...................................................................................................................................9
Question 5:...................................................................................................................................9
Question 6:...................................................................................................................................9
Question 7:.................................................................................................................................10

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Question 8:.................................................................................................................................10
Question 9:.................................................................................................................................10
Question 10:...............................................................................................................................11
References:....................................................................................................................................12

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Case study 1:
Question 1:
The nervous system performs three general functions in the body, a sensory function, an
interpretative function and a motor function as well. The sensory nerves gather information from
the body as well as the external environment and the nerves help to carry the information to the
central nervous system. The sensory information is processed and interpreted in the central
nervous system and response is generated. The response information is conveyed from the
central nervous system to the rest of the body via motor nerves (Nieuwenhuys, Hansand
Nicholson 2014).
Question 2:
Multiple sclerosis can be defined as an immune controlled inflammatory disease, it
targets the central nervous system of the patent by attacking the myelinated axons in the central
nervous system. It can be mentioned that the targeting of the myelinated axons results into
destruction of myelin and axon in variable degrees, producing significant disability in the 30% of
the patient within a time frame of 20 to 25 years. The manifestation of this disease is facilitated
by the production of demyelinating lesions of MS also known as plaques.
Question 3:
The musculoskeletal system provide structural support to the body, the bones help in
storing minerals and lipids and is the site of production of blood cells, 70% of the total calcium
count of the boy is stored in the bones. The bones also protect the body organs and soft tissues
from external stimuli or impact and also provide leverage and movement, the muscular system

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generates the main locomotive force in the body and the skeletal system levers and controls the
magnitude and direction of the movement (Taylor 2013).
Question 4:
There is a significant impact of the multiple sclerosis on the musculoskeletal system as
well. Multiple sclerosis often causes an acute neuropathic or musculoskeletal pain caused by the
targeting of the nociceptors. Nociceptors are the free nerve endings that that help in detection of
the pain stimulus and its subsequent interpretation. They remain protected by myelin in all types
of body tissue s except for in the brain. As multiple sclerosis facilitates myelin degeneration, it
facilitates an acute musculoskeletal pain by the nociceptors detecting actual tissue damage
(Neumann 2013).
Question 5:
Exploring on the signs and symptoms that the patient had been suffering from, blurry
vision is a key symptom associated with this condition. The first set of signs and symptoms
associated with the multiple sclerosis is called the clinical isolated syndrome or CIS, and the
blurry vision is one of the most common manifestations (Notcutt et al. 2012). The
pathophysilogy behind the blurry vision experienced by the patent is due to the occurrence of
optic neuritis, this damages the nerve between the eye and brain causing disruption in neuron
signal exchange, resulting in blurring the vision of the patient. The next symptom had been
bilateral numbness in the both legs; it generally is the first stage of muscle spasm and stiffness.
According to the Pilutti et al. (2014), multiple sclerosis reduces muscle spasticity in the patient
making them stiff and resistant and leads to spasm when trying to move the muscles. The third
symptom that the patient had been facing had been urinary urgency which is a very common
phenomenon in multiple sclerosis; this disease often causes a spastic or overactive bladder that is

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unable to hold even normal amount of urine; along with that, this condition even enhances the
vulnerability of the patient to urinary tract infections as well. Along with that it has to be
mentioned that poor focus, slowed thinking and fuzzy memory are another key symptom of the
multiple sclerosis. The presence of the multiple lesions and damage to the blood brain barrier can
cause gradual loss of cognitive functions leading to loss of memory. The last symptom exhibited
by the patient had been poor balance and walking difficulties due to the reduction of muscle
spasticity and fatigue.
Question 6:
The integumentary system of the body consists of skin, hair, nails, glands, and nerves.
The main function facilitated by the integumentary system is to act as a barrier to protect the
body from the external stimuli and harmful impacts. The integumentary system also helps in
retaining body fluids, provides protection against diseases, eliminates waste products and also
helps in regulating the body temperature of the individual (McLafferty, Hendry and Farley
2012).
Question 7:
Both eczema and psoriasis are skin diseases that damage the skin integrity of the patient
and affects the integumentary system o the body as well. First and foremost, eczema an be
defined as the reaction pattern of the skin to a number of diseases. It mainly targets the dermis of
the integumentary system by producing red elevated plaques topped by tiny raised blisters
containing clear fluid. As the disease progresses it also causes thickening and scaling of the
affected tissue and it is always itchy (von Kobyletzki et al. 2014).

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Psoriasis, on the other hand, is a noncontiguous, chronic skin condition that causes
production of plaques produced by thickened scaling skin. This is another integumentary system
disease with manifestations limited to the dermis. On a more elaborative note, it causes dry
flakes of the skin caused by rapid proliferation of skin cells as well. It mainly affects the knee,
elbows, and scalp but is can also target the skin of the torso, palms and the soles of the feet
(Bushmakin et al. 2015).
Question 8:
The most common type of treatment interventions are a handful of pharmacological
interventions. First and foremost, hydrocortisone ointment is given to the patient to help is
calming the lesions. Antihistamines are oral tablets which are also given to the eczema patients
that help in controlling the occurrence of the blisters. Corticosteroids are also given in
conjuncture of this medication to calm the manifestation spread of the medication (von
Kobyletzki et al. 2014).
In case of psoriasis, the treatment options are also topical antibiotics such as topical
corticosteroids that help in reducing the inflammation and helps in relieving itching as well.
Anthralin is another topical medication that helps in slowing down the rate of skin cell growth
and can help in removing the scales smoothing out the skin (Bushmakin et al. 2015).
Question 9:
First and foremost the patient will require interventions for the urinary urgency that the
patient is suffering from which significantly enhances her risk of acquiring urinary tract
infections. based on my assessment of urgency, I would require administration of medications
such as oxybutanin, propanthalene, hyoscyamine sulfate and tolterodine which will help in

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reducing the bladder spasticity which will help in reducing the urinary urgency of the patient
(Lublin et al. 2014). Another urgency that I have discovered in the assessment is the self care
deficitdue the high muscular spasticity, unstable gait and abnormal sensations which can deter
her from successfully perform self care or activities of daily living. I would administer
medications such as Tizanidine, baclofen, carbamezepine which will promote muscle relaxation
and inhibit spinal root level reflex helping calm thee muscle spasm and related discomfort.
Question 10:
In the care planning for the patient in the case study, the patent will require the attention
of the medical practitioner who will assess the disease progression of the patient and will provide
necessary pharmacological and non-pharmacological interventions for the patient. He next health
professional will be the physiotherapists who will help in muscle relaxation and reducing the
impact of the bone decay. Lastly, Daisy will require the assistance of an allied health
professional, preferably a dietician which will help her with a mineral and antioxidant rich diet to
overcome bone decay and aging associated with multiple sclerosis (Cohen et al. 2012).

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Case study 2:
Question 1:
The cardiovascular system is comprised of heart and an intricate network of blood vessels
including blood veins, capillaries and arteries. The heart remains connected with the rest of the
body by the means of the connective tissue blood and the network of blood vessels (Brown and
Griendling 2015).
Question 2:
The main function of the cardiovascular system is to provide oxygenated blood to the rest
of the body and supply the deoxygenated blood from the body to the lungs. On a more
elaborative note, arteries are the blood vessels that take the oxygenated blood away from the
heart to the rest of the body. The veins help in returning the deoxygenated blood to the heart.
And the heart helps to pump the blood for transport of oxygen, nutrients and hormones
throughout the body and helps in removal of metabolic wastes (Yang et al. 2013).
Question 3:
Aging as a significant impact on each and every functioning system of the body and
hence the cardiovascular system also is effected by the process of aging. In the process of aging,
the natural pacemaker loses some cells and becomes rigid leading to atrial fibrillation. With
aging the muscles of the left ventricle become thicker and even the heart can increase in size
declining the volume of the left ventricle. It results is reduction of the pumping ability of the
heart and leads to decreased circulatory output (McEvoy and Shander 2013).

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Question 4:
Angina can be defined as the chest pain or pressure that is developed during a myocardial
infarction. It is also known as angina pectoris and the underlying pathophysiology of the
condition is due to the heart muscles not getting enough oxygenated blood. Elaborating more,
coronary arteries often are obstructed due to coronaries arterial spasms and coronary blockages.
The coronary arteries become blocked due to cholesterol deposition by the process of
atheroschlerosis leading to obstructed blood flow of the main arteries and gives rise to angina
(McEvoy and Shander 2013).
Question 5:
The patient John in the case study had angina or acute chest pain when he was engaged in
some activity and it reduced when he was resting. The underlying reason behind the same can be
the fact the patient had effort angina or stable angina which is a classic symptom of myocardial
ischemia. During any exerting activity the energy consumption is higher increasing the oxygen
requirement of the body leading to higher burden on the heart to pump more blood. With blocked
arteries it exerts pressure on the left ventricle and leads to angina. During resting there is no
exertion of excess energy and hence the pressure on the heart is also reduced, which results into
the angina subsiding (Koralkova, Solinge and Wijk 2014).
Question 6:
Anemia is a disease that is facilitated by anomaly in the RBC production and destruction,
there are many causes behind the anemia. The disturbance with proliferation and differentiation
of the stem cells can be one reason behind the disease, along with that, enhanced destruction of
the RBC also results in anemia. The signs and symptoms include weakness, fatigue, shortness of

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breath, and in severe anemia even increased cardiac output and angina. The risk of anemia are
facilitated by low iron diet, low vitamin or mineral intake, chronic diseases like kidney disorder,
rheumatoid arthritis, thyroid, gastritis, and heart failure (Young 2013).
Question 7:
As John had been struggling with anemia his hemoglobin levels are reduced in th blood
stream. With reduced hemoglobin levels in the body, the ability of his blood to deliver sufficient
oxygen to the brain, heart, muscles and other key organs is compromised as well. And hence the
patient feels increasing tired and fatigued. Along with that, due to the lack of sufficient oxygen
delivery to the entire body, the oxygen demand is increased with extra pressure on he lungs and
the heart to overcompensate the oxygen requirement of the body. This led to labored breathing in
the patient and caused shortness of breath (Lavie et al. 2015).
Question 8:
Hemoglobin is the complex protein that is found in the red blood cells, they contain an
iron molecule and functions as the key oxygen binding molecule. It helps in carrying oxygen to
the rest of the body (Young 2013).
The normal levels of hemoglobin in a adult is 13.5 to 17.5 grams per deciliter of blood
for an adult male.
Question 9:
Based on the key signs and symptoms that John is exhibiting, I would order an arterial
blood gases assessment for the patient to obtain the pH levels and I would recommend serum
iron level testing as well.
The lifestyle recommendations will include:

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 Taking an iron rich diet for the patient to increase the hemoglobin count.
 Taking iron supplements that will facilitate hemoglobin level increase in
the body.
 Asking the patient to quit smoking and quit his sedentary lifestyle and
adapt a healthier lifestyle with healthy eating and regular exercise (Young
2013).
Question 10:
The first health professional would be a cardiologist to assess and treat his cardiac
complications. The second health professionals will be a dietician who will help in guiding the
patient to switch to a healthy and iron rich diet. The third health professional will be an allied
health professional, a physiotherapist who will help him develop healthy exercise regimen
(Koralkova, Solinge and Wijk 2014).

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References:
Bushmakin, A.G., Mamolo, C., Cappelleri, J.C. and Stewart, M., 2015. The relationship between
pruritus and the clinical signs of psoriasis in patients receiving tofacitinib. Journal of
Dermatological Treatment, 26(1), pp.19-22.
Cohen, J.A., Coles, A.J., Arnold, D.L., Confavreux, C., Fox, E.J., Hartung, H.P., Havrdova, E.,
Selmaj, K.W., Weiner, H.L., Fisher, E. and Brinar, V.V., 2012. Alemtuzumab versus interferon
beta 1a as first-line treatment for patients with relapsing-remitting multiple sclerosis: a
randomised controlled phase 3 trial. The Lancet, 380(9856), pp.1819-1828.
Koralkova, P., Solinge, W.W. and Wijk, R., 2014. Rare hereditary red blood cell enzymopathies
associated with hemolytic anemia–pathophysiology, clinical aspects, and laboratory
diagnosis. International journal of laboratory hematology, 36(3), pp.388-397.
Lavie, C.J., Arena, R., Swift, D.L., Johannsen, N.M., Sui, X., Lee, D.C., Earnest, C.P., Church,
T.S., O’keefe, J.H., Milani, R.V. and Blair, S.N., 2015. Exercise and the cardiovascular system:
clinical science and cardiovascular outcomes. Circulation research, 117(2), pp.207-219.
Lublin, F.D., Reingold, S.C., Cohen, J.A., Cutter, G.R., Sørensen, P.S., Thompson, A.J.,
Wolinsky, J.S., Balcer, L.J., Banwell, B., Barkhof, F. and Bebo, B., 2014. Defining the clinical
course of multiple sclerosis The 2013 revisions. Neurology, 83(3), pp.278-286.
McEvoy, M.T. and Shander, A., 2013. Anemia, bleeding, and blood transfusion in the intensive
care unit: causes, risks, costs, and new strategies. American Journal of Critical Care, 22(6),
pp.eS1-eS13.

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McLafferty, E., Hendry, C. and Farley, A., 2012. The integumentary system: anatomy,
physiology and function of skin. Nursing Standard (through 2013), 27(3), p.35.
Neumann, D.A., 2013. Kinesiology of the Musculoskeletal System-E-Book: Foundations for
Rehabilitation. Elsevier Health Sciences.
Nieuwenhuys, R., Hans, J. and Nicholson, C., 2014. The central nervous system of vertebrates.
Springer.
Notcutt, W., Langford, R., Davies, P., Ratcliffe, S. and Potts, R., 2012. A placebo-controlled,
parallel-group, randomized withdrawal study of subjects with symptoms of spasticity due to
multiple sclerosis who are receiving long-term Sativex®(nabiximols). Multiple Sclerosis
Journal, 18(2), pp.219-228.
Pilutti, L.A., Dlugonski, D., Sandroff, B.M., Klaren, R. and Motl, R.W., 2014. Randomized
controlled trial of a behavioral intervention targeting symptoms and physical activity in multiple
sclerosis. Multiple Sclerosis Journal, 20(5), pp.594-601.
Taylor, R.B., 2013. The Musculoskeletal System. In Diagnostic Principles and Applications (pp.
235-260). Springer, New York, NY.
von Kobyletzki, L., Svensson, Å., Schmitt, J., Chalmers, J. and Thomas, K., 2014. Eczema Signs
and Symptoms: what is important to patients?. Br J Dermatol, 170(6 Suppl), p.e11.
Yang, X., Piety, N.Z., Vignes, S.M., Benton, M.S., Kanter, J. and Shevkoplyas, S.S., 2013.
Simple paper-based test for measuring blood hemoglobin concentration in resource-limited
settings. Clinical chemistry, 59(10), pp.1506-1513.

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Young, N.S., 2013. Current concepts in the pathophysiology and treatment of aplastic
anemia. ASH Education Program Book, 2013(1), pp.76-81.