HNB3004 - Nursing For Chronic Illness and Continuing Care Assessment Answer

Case Scenario

Lucy Williams, a 38-year-old mother of three young children, was diagnosed with MS (Multiple Sclerosis) 8 years ago following tingling and muscle spasms in her arms. She was also diagnosed with optic neuritis a few months before MS diagnosis. The diagnosis was confirmed after a range of tests. Lucy was a full-time primary school teacher. Lucy was informed that she may not be able to work full-time and take care of her family. Also, she had a few MS attacks and lost vision in her left eye. However, Lucy managed to continue her teaching job 3 days a week till last month. Lucy has developed increased weakness in her left side and cerebellar ataxia. She has taken some leave from work with no clarity of whether she will be able to continue the job. Lucy feels like her social life has ceased. Lucy is grateful for her supportive family but worried she will be a burden to them. Her neurologist suggested starting injection therapy to minimise the severity of MS.   

Please Consider the Following Points When you Attend this Assessment  

• Describe briefly patient information linked with the diagnosis and pathophysiology  
• Risk factors to develop MS  
• Describe the prevalence of the patient’s current diagnosis in Australia and compare it with global statistics.   
• Discuss the impact of disease on the person living with the illness and their family 
• Formulate health promotional activities to maintain the quality of life of someone living with this condition 
• Propose strategies to manage the selected chronic condition by providing collaborative care. 

Answers

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system that affects nearly 2 million people worldwide. It is a common, chronic, disabling disease of the central nervous system (CNS). The cause remains unknown, although it is believed to involve a combination of environmental and genetic factors. MS is characterized by attacks in which abnormal or autoreactive immune cells damage the myelin sheath around nerve cells, leading to loss of function. It is typically diagnosed after the appearance of new neurological symptoms, which may be the result of recurrent inflammation or an attack of inflammation. The most common symptom is inflammatory brain damage, which is manifest as neurological deficits that can range from minor symptoms such as memory loss to more serious problems such as paralysis or blindness. The classic staging system for multiple sclerosis divides the disease into three stages: primary, secondary, and chronic. 

Treatment of multiple sclerosis typically focuses on relieving the symptoms of brain damage and preventing further inflammatory attack. Common treatments include medicines to reduce inflammation, physiotherapy to improve movement and function, and various forms of surgery, including decompressive neurosurgery and endoscopic neurosurgery. 

Risk Factors for Developing Multiple Sclerosis are listed Below: 

Genetic Predisposition 

Multiple Sclerosis (MS) is majorly classified as a relapsing and progressing chronic autoimmune disorder. MS affects approximately 2.5 million individuals worldwide. Although, the causes of MS remains largely unknown; however, genetic susceptibility is suspected to play a role in the pathogenesis. A number of genes have been identified that may contribute to the risk of developing MS. However, only certain combinations of these genes increase the risk of developing MS, while others reduce this risk. 

Infection 

Infections are known triggers of MS relapses. Viruses are implicated in triggering MS attacks in some patients. One study showed that Epstein Barr virus was detected in the cerebrospinal fluid of 50% of MS patients. Other viruses associated with MS include cytomegalovirus, varicella zoster virus, human herpesvirus 6, and human immunodeficiency virus. 

Autoimmunity

Autoimmune diseases occur when the body mounts an immune attack against itself. This results in damage to the target organ. Several studies suggest that autoimmunity contributes to the pathogenesis of MS. Antibodies directed against myelin antigens have been detected in MS patients. Furthermore, T cells reactive to myelin antigens are present in MS lesions. 

Demyelination 

Demyelination occurs when the insulating sheath surrounding nerve fibres becomes damaged. Demyelination leads to conduction block and axonal degeneration. Myelin destruction is thought to be mediated by activated macrophages and microglia. 

Data that are global 2013 to 2020 implies the reported prevalence of multiple sclerosis has increased from approximately 2.3 million to 2.8 million, in line with the Atlas of MS. Prevalence of multiple sclerosis per 100,000 population by globe region in 2013 and 2020. Prevalence of multiple sclerosis per 100,000 population by world region in 2013 and 2020. Australians now live with the situation which can be a growth of 4,400 over the past 8 years, with on average about 10 Australians being diagnosed with MS every week. But although the prevalence is increasing, MS stays securely under our radar with just 4 out of 10 australians MS that is ranking a wellness priority. The fact that multiple sclerosis is most prevalent in northern Europe, North America, Australia and New Zealand has led to conjecture it has been carried round the global world by European colonists and settlers. It's been suggested that the origins can right back be traced to the Vikings who colonised those elements of Northern Europe where MS is many pronounced and that 'Viking genes' can make people especially prone to MS. A straightforward geographic spread is not the picture that is whole. Studies show that certain groups which are ethnic a markedly lower prevalence of multiple sclerosis, despite living in countries where MS is common. For instance, the Sami or Lapps of north Scandinavia additionally the Inuits in Canada have very low prices of MS. A pattern that is comparable observed amongst the Maoris of the New Zealand. 

The impact of MS on people varies enormously depending on the person’s stage of development, level of severity, experience and type or variant of MS. For some people with early onset or relapsing-remitting multiple sclerosis (ERSM), the diagnosis may come as quite a shock and lead to feelings such as disbelief or confusion – often followed by depression and anxiety. MS affects the person living with the illness and their family in many ways. For example, MS can cause difficulty with daily tasks such as walking, talking, and getting out of bed. It can also affect a person's mood, ability to think clearly, and capacity for social interaction. In addition, MS often causes problems with physical function, such as poor balance and coordination, difficulty swallowing, and difficulty breathing. spouses and family members of people with MS are often required to take on many of the roles that would typically be assumed by a spouse or other family member. The impact of MS on the individual can be life-changing, and the impact of MS on the family can be emotionally difficult. MS often plagues families with tremendous physical and emotional demands. In addition to coping with the individual's symptoms and health concerns, families may also need to deal with the financial implications of MS, such as the cost of medical treatments and therapies, travel expenses, and lost wages. Ways to cope with MS can vary depending on the individual and their family situation. For some people, coping may involve spending time with friends and family, participating in physical activity, or using coping strategies such as prayer or meditation. Other people may find support groups helpful. regardless of the individual's coping mechanisms, it is important to find something that makes them feel good and helps them to cope with MS in a productive way. Above all, the person must need to understand that MS is a lifelong illness actually an autoimmune condition which will prevail with him/her lifetime. 

Symptoms of MS include recurrent attacks on muscles, tendons, nerves and joints as well as problems with vision, balance and mobility. Although there is no cure for Multiple Sclerosis (MS), treatments available help people cope with its symptoms. Keeping in mind the needs and wants of those living with Multiple Sclerosis, it is important to focus on the five W's- who, what, when, where, and why. To reach those who need information the most, it is important to organize events and provide educational materials in an engaging, easy-to-understand format. Online directory of health-related resources, including information on living with Multiple Sclerosis, as well as information on treatments and therapies should be created. One way of reaching out to those living with MS is through informational interviews. Appointments should be setup with those who are known to have MS and interested in learning more about MS and how to maintain their quality of life. Information about MS and its impact on daily activities should be distributed through door-to-door visits, community events, and print and electronic materials. To this end, it would be best to design materials in an accessible, color-coded format, as well as produce videos and podcasts that are easy to watch and listen to. The materials should be made available in multiple languages to make sure that everyone with MS can access them. 

Multiple sclerosis (MS) is a chronic, often disabling disease that affects the central nervous system. Symptoms may include problems with vision, movement, and balance; fatigue; seizures; bowel and bladder problems; depression or anxiety disorders; cognitive decline or memory loss. Although most people with MS get better over time, some experience long-term disability. Management of MS includes providing support to prevent relapses and minimizing symptoms. Managing MS is a collaborative effort involving the individual with MS, their caregivers, and their healthcare providers. Each person has a unique set of needs that must be met in order to manage their MS effectively. The following are some suggested strategies for managing MS: 

Finding a support group or program -support groups that offer people with MS a place to share their experiences and challenges, as well as resources to help them manage their condition. 

Communicating with your healthcare provider about managing the condition. It is important to properly communicate any changes or challenges the person is experiencing, as well as the medications and treatments he/she is taking. 

Managing symptoms and side effects - symptoms can vary greatly from person to person, so it is important to understand your own symptoms and try to manage them as best as possible. Managing MS can be difficult, but with the help of a supportive community and knowledgeable healthcare providers, it can be possible to live a full and productive life. 

References

Dobson, R., & Giovannoni, G. (2019). Multiple sclerosis–a review.  European journal of neurology,  26 (1), 27-40. 

Feinstein, A. (2004). The neuropsychiatry of multiple sclerosis.  The Canadian Journal of Psychiatry,  49 (3), 157-163. 

Sospedra, M., & Martin, R. (2005). Immunology of multiple sclerosis.  Annual review of immunology ,  23 (1), 683-747. 

Goldenberg, M. M. (2012). Multiple sclerosis review.  Pharmacy and therapeutics,  37 (3), 175. 

Hammond, S. R., McLeod, J. G., Macaskill, P., & English, D. R. (1996). Multiple sclerosis in Australia: socioeconomic factors.  Journal of Neurology, Neurosurgery & Psychiatry ,  61 (3), 311-313. 

McLeod, J. G., Hammond, S. R., & Hallpike, J. F. (1994). Epidemiology of multiple sclerosis in Australia: with NSW and SA survey results.  Medical Journal of Australia ,  160 (3), 117-122. 

Palmer, A. J., Colman, S., O’Leary, B., Taylor, B. V., & Simmons, R. D. (2013). The economic impact of multiple sclerosis in Australia in 2010.  Multiple Sclerosis Journal,  19 (12), 1640-1646. 

Hammond, S. R., McLeod, J. G., Macaskill, P., & English, D. R. (2000). Multiple sclerosis in Australia: prognostic factors.  Journal of clinical neuroscience,  7 (1), 16-19. 

Rudick, R. A., Cohen, J. A., Weinstock-Guttman, B., Kinkel, R. P., & Ransohoff, R. M. (1997). Management of multiple sclerosis.  New England Journal of Medicine ,  337 (22), 1604-1611. 

Barten, L. J., Allington, D. R., Procacci, K. A., & Rivey, M. P. (2010). New approaches in the management of multiple sclerosis.  Drug design, development and therapy,  4, 343. 

Barten, L. J., Allington, D. R., Procacci, K. A., & Rivey, M. P. (2010). New approaches in the management of multiple sclerosis.  Drug design, development, and therapy,  4, 343. 

Marziniak, M., Brichetto, G., Feys, P., Meyding-Lamadé, U., Vernon, K., & Meuth, S. G. (2018). The use of digital and remote communication technologies as a tool for multiple sclerosis management: narrative review.  JMIR rehabilitation and assistive technologies ,  5 (1), e7805. 

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