Nursing Case Study: Comprehensive Care for Multiple Sclerosis Patient

This nursing case study focuses on Andrea Stevenson, a 39-year-old woman diagnosed with relapse-remitting multiple sclerosis. The study comprehensively assesses Andrea's physical, environmental, physiological, and psychological needs, detailing appropriate nursing interventions to manage her condition. It addresses the impact of Andrea's illness on her family, particularly her husband and three children, and suggests supportive services to alleviate their burdens. The case study further explores different types of pain associated with multiple sclerosis and proposes both pharmaceutical and non-pharmaceutical pain management strategies. It also identifies appropriate medications for managing muscle spasms and neuralgia, and assistive services to support the well-being of Andrea's children. The prognosis of multiple sclerosis, specifically the relapse-remitting type, is also discussed, highlighting the autoimmune nature of the disorder and its impact on the central nervous system.

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
Question 1:.......................................................................................................................................2
Question 2:.......................................................................................................................................3
Question 3:.......................................................................................................................................4
Question 4:.......................................................................................................................................5
Question 5:.......................................................................................................................................6
Question 6:.......................................................................................................................................8
Question 7:.....................................................................................................................................10
Question 8:.....................................................................................................................................11
Question 9:.....................................................................................................................................12
References:....................................................................................................................................13

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Question 1:
Assessment Rationale
Physical Physical assessment is one necessary assessment technique for
multiple sclerosis patients as relapse remitting multiple sclerosis is
associated with many neuromuscular degeneration. Lhermitte’s sign,
spasticity and increased reflexes, internuclear ophthalmoplegia,
optic neuroritis and gait or balance disturbance are few of the key
symptoms of multiple sclerosis which can be assessed by physical
assessment (Learmonth et al., 2012).
Environmental As Andrea had been suffering from extreme gait disturbance and
mobility restriction, the fall risk is very high for her. Along with that
as she needed assistance in most of the activities of daily living,
environmental assessment had been necessary for her (Lublin et al.,
2014).
Physiological As Andrea had been suffering from many physiological
manifestations of multiple sclerosis such as gait disturbance,
incontinence, pain, fatigue and motor function disturbance. Hence,
the physiological assessment will help in discovering the severity of
her symptoms (Learmonth et al., 2012).
Psychological Depression is often a significant aftermath of the challenges
associated with relapse remitting multiple sclerosis and hence

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psychological assessment is extremely important for the community
nurse to understand whether or not she requires counselling to cope
with her condition (Lublin et al., 2014). As Andrea had been
suffering from uncertainty and inadequacy worrying about her
marriage and family, a psychological assessment will be necessary
for her.
Question 2:
Assessment Intervention Evaluation
1. Physical
(mobility
deficits)
The community nurse will
provide gait training, gait
assistive devices, powered
mobility equipment, wheelchair,
and mobility assistive strategies
(Coote, Hogan & Franklin, 2013).
These assistive services will help
provide Andrea with the
opportunity to control and
manage her mobility restrictions
and will aid in empowering her.
The outcome efficiency of this
strategy can be assessed by
feedback from the patient and her
family members.
2. Environmenta
l
(fall risk)
The community nurse will
provide environmental
modifications such as de-
cluttering the physical
The de-cluttering and other such
environmental modifications will
help Andrea evade the fall risk;
the aid of supportive footwear

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environment and enhancing the
light and visibility of her living
space along with vestibular
rehabilitation including the aid of
supportive nonskid footwear.
and vestibular rehabilitation will
help her progress effectively.
This outcome can be evaluated by
periodic fall assessment and one-
to-one feedback session (Lublin
et al., 2014).
3. Physiological
(spasms in her
legs)
The nurse will provide the aid of
stretching exercise, cooling
strategies, standing frame,
positioning aid, and baclofen
pump (Amatya et al., 2013).
These assistive devices and
interventions will help reduce the
frequency and impact of the spam
and will help her feel better. This
outcome can also be evaluated
with feedback sessions.
4. Psychological
(onset of
depression)
The nurse will provide the aid of
cognitive behavioral therapy,
mindfulness based therapies and
counselling assistance (Simpson
et al., 2014).
The psychotherapies will help
Andrea cope with the challenges
of multiple sclerosis and improve
the quality of her life.
Question 3:
1. Physical:
As the impact of relapse-remitting multiple sclerosis has rendered Andrea unable
to take part in any of the responsibilities of the household, her husband has had to

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shoulder the responsibility of their three children and along with that Andrea as well. As
he also had been the only earning member of the family, the additional responsibilities
will undoubtedly have a toll on his time and energy rendering him fatigues and exhausted
(Pakenham, Tilling & Cretchley, 2012).
2. Psychological:
The impact of neurodegenerative disorder often renders one person incapable of
standard state of functionality, and watching a loved one suffer through the extreme
challenges of relapse remitting multiple sclerosis will have a severe impact on the
psychological state of Andrea’s husband.
3. Financial:
Both Andrea and Daniel had been working both contributed equally to their
household and taking care of three growing children. Now, Andrea had to resign from her
job due to the loss of functionality due to the relapse remitting multiple sclerosis. Along
with that, the extensive treatment and assistance that Andrea required due to her
progressing condition will also have a significant financial strain on Daniel as the only
earning member (Pakenham & Samios, 2013).
Question 4:
1. Physical:
In this case, the nurse will require to recommend the aid of a social care worker who can
take the responsibility of caring for his wife and in turn provide him reprieve. Along with
that the nurse can also recommend the assistance of occupational therapists to help him with
the fatigue and exhaustion

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2. Psychological:
The community nurse can provide counselling and community engagement interventions
to Daniel as preliminary psychotherapeutic assistance. However, in case Daniel needs more
specialized assistance, the community nurse will need to recommend him to a
psychotherapist (Uccelli, 2014).
3. Financial:
Although the scope of practice of a community nurse does not extend to providing
financial recommendations to the patient family, although in this case, the nurse can educate
Daniel about the national disability schemes and other community care benefits that the
patients with neurological disabilities are applicable for under the state and national policies
taking the aid of evidence based practice.
Question 5:
Type of pain Cause of pain
1. Trigeminal neuralgia This is a kind of facial pain syndrome that is very common in
people with multiple sclerosis (Montano et al., 2013). This is
particularly a sharp and electrical jabbing pain that generally
occurs on one cheek; although the pain is very severe but
only lasts for a few seconds. The cause of the pain is the
damage to the myelin sheath that surrounds the trigeminal
nerve due to the onset of multiple sclerosis. As the trigeminal
nerve is responsible for chewing or feeling the sensation of
pain in the face, the damage to this nerve causes the sharp,

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electric pain, which is often triggered by daily activities
(Tuleasca et al., 2014).
2. Burning limb pain The second type of the pain that is caused by this particular
disease is the burning pain that is generally caused in the legs
but might occur anywhere else in the body. This particular
pain is also associated with sensitivity to the touch, however,
researchers are of the opinion that the affected leg can also
feel cold to touch as well (Foley, 2017). Exploring the cause
of this particular pain, it has to be mentioned that the
extensive demyelination that is associated with relapse-
remitting multiple sclerosis causes significant damage to the
central nervous system of the patient along with the brain
tissues. As a result, the sensory signals that to the spinal cord
and the brain are altered facilitating burning pain sensations.
3. Neck and back pain Another common type of pain that patients of multiple
sclerosis experiences includes an aching stiff sensation in the
neck of the patient which may or may not radiate to the back
of the patient as well. According to Solaro, Trabucco and
Uccelli, 2013, this pain can be moderate to severe and is
mainly caused by long term immobility. Furthermore, it has
to be mentioned that this type of pain is basically a
musculoskeletal or nociceptive pain that is caused to the
muscles, tendons, ligaments and soft tissue for prolonged

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period of immobility.
4. Multiple sclerosis hug This is a very common pain type that is associated with the
construct of multiple sclerosis. This is a banding of girdling
pain sensation in the chest that the Multiple sclerosis patients
undergo. In certain cases this pain is also associated with rib
pain, and tightness or being squeezed around the chest as
well. The cause of this particular pain is co9llective spasms
in the intercostal muscles located in the rib and surrounding
muscles and the spasms in the surrounding tissue causes the
sensation of the pain in the chest pain (Montano et al., 2013).
Question 6:
Non-pharmaceutical Intervention Justification
1. Exercise and yoga Exercise and yoga is one of the greatest non-
pharmacological treatment opted as the
complementary or alternative treatment
measure taken for the pain management in
severe conditions such as the relapse
remitting multiple sclerosis. It helps in blood
circulation which in turn has a positive impact
on the impact of pain felt by the patient.
Along with that, it also helps in diverting the

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attention of the patient from the pain to peace
and contentment in turn helping in better pain
management (Ambrose & Golightly, 2015).
2. Acupuncture Acupuncture is another very common
nonpharmacological treatment measure which
has been found to be extremely beneficial in
treating pain and the origin of this treatment
has been inn ancient china as early as 8000
years ago. According to authors, it helps in
unblocking or otherwise redirecting the flow
of energy which helps lessen the sensation of
pain and helps the patient suffering from pain
focus on something other than the pain.
3. Mindfulness based therapy Mindfulness based cognitive therapies help in
chronic pain management by altering the
quality and state of consciousness and paying
attention on the purpose or the outcome of the
therapy. This particular therapy will help
Andrea focus on attaining freedom of mind
and freedom from reflexive conditioning
helping her overcome the pain (Uccelli,
2014).

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4. Magnet therapy This is another alternative treatment option
for pain management which is gaining rapid
popularity for its effectiveness. This
therapeutic measure involves the utilization of
static or unmoving magnets to alleviate the
feeling or sensation of pain. Researchers are
of the opinion that static magnets function in
pain management by altering the
bioenergetics fields of the person and helping
them ignore the sensation of pain.
Question 7:
Drug Class of Drug Indication
Baclofen Antispasticity agents
(muscle relaxant)
This particular medication is
generally used to treat the muscle
spasms occurring in the multiple
sclerosis for the relief of flexor
spasms and concomitant pain. Is
administered intrathecally
(Draulans et al., 2013).
Diazepam Benzodiazepines Is used as adjunctive treatment of
spastic muscular paresis that are

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caused by muscular sclerosis,
administered orally
Gabapentin Anticonnvulsant Is used as adjunctive therapy for
partial seizures for patients with
neuralgia due to multiple sclerosis,
taken orally (Turcotte et al., 2015).
Question 8:
1. The impact of a parent with a progressive neurological condition has a significant impact
on the psychological health and sanity of the children. According to Parisé et al. (2013),
the impact of neurological and physical disability of a parent is significantly profound on
the growing children, especially on those aged five to 10. As Andrea and Daniel had
three children belonging to age 11, 7 and 5, the impact of their mother’s disability could
have had a significant impact on their psyche. Hence, the first assistive service that the
parents can take the assistance from in ensuring optimal health of their children is a child
psychiatrist.
2. The second assistive service that the parents can take the assistance from is a child health
and welfare committee. It has to be mentioned that for the children growing up on their
own with a disabled and severely sick parent can have growth dysfunction or
developmental restrictions (Pakenham, Tilling & Cretchley, 2012). In such cases, the aid
of a dietician, counselor and therapeutic counsellor is imperative. The child welfare
centers can help both Andrea and Daniel in periodic assessment of the health of their
children, both physical and psychological.

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Question 9:
Prognosis of multiple sclerosis is generally dependent on the type of multiple sclerosis
that the patient is going through. In this case, Andrea, the patient in the case study, has been
suffering from relapse remitting multiple sclerosis which is an autoimmune disorder where the
autoimmune system attacks the central nervous system of the patient. This particular
neurodegenerative condition represents physical, psychological and emotional challenges and
directly affects the living condition and lifestyle of the patient, imposing several restrictions, as
observed in the case of Andrea as well, facilitated by the muscular spams, mobility restrictions,
gait disturbance, incontinence struggle and pain (Ascherio, 2013). With respect to her condition,
she is expected to experience optic disturbances and speech difficulties as her disease progresses.
However, relapse remitting multiple sclerosis does not pose an immediate life threat to the
patient and many patients live a long life with adequate assistance from the care professionals.
Hence, with adequate treatment and assistive support, Andrea can also be expected to have a
long life with better coping and symptomatic management.

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References:
Amatya, B., Khan, F., La, L. M., Demetrios, M., & Wade, D. T. (2013). Non pharmacological
interventions for spasticity in multiple sclerosis.
Ambrose, K. R., & Golightly, Y. M. (2015). Physical exercise as non-pharmacological treatment
of chronic pain: why and when. Best Practice & Research Clinical Rheumatology, 29(1),
120-130.
Ascherio, A. (2013). Environmental factors in multiple sclerosis. Expert review of
neurotherapeutics, 13(sup2), 3-9.
Coote, S., Hogan, N., & Franklin, S. (2013). Falls in people with multiple sclerosis who use a
walking aid: prevalence, factors, and effect of strength and balance
interventions. Archives of Physical Medicine and Rehabilitation, 94(4), 616-621.
Draulans, N., Vermeersch, K., Degraeuwe, B., Meurrens, T., Peers, K., Nuttin, B., & Kiekens, C.
(2013). Intrathecal baclofen in multiple sclerosis and spinal cord injury: complications
and long-term dosage evolution. Clinical rehabilitation, 27(12), 1137-1143.
Foley, P. L. (2017). Pain in multiple sclerosis (Doctoral dissertation, University of Edinburgh).
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Bebo, B. (2014). Defining the clinical course of multiple sclerosis: the 2013
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Montano, N., Papacci, F., Cioni, B., Di Bonaventura, R., & Meglio, M. (2013). What is the best
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