Exam practice question need help please!

FunkiMunki · May 8, 2008

Help exams soon can you please help with this practice question?
A 45 yr old gentleman with progressive Multiple Sclerosis is admitted for assessment and control of symptoms. He lives with his wife and teenage
daughter, is confined to a wheelchair by day, is experiencing some muscular pain and has difficulty with eliminating.
Give a detailed account of the nursing management of this patient (50 marks)
FINALLY WORKED OUT HOW TO PASTE IT!!
Multiple Sclerosis
- chronic, progressive, degenerative disease characterised by patches
of demyelation throughout brain & spinal cord. Myelin is lipoprotein sheath
surrounding axons of the neurones & enables impulses to travel much faster along the fibre than is possible in unmyelinated fibres. The destruction of areas of myelin is followed by proliferation of neuroglial. Scar tissue forms as hardened (sclerotic) white elevations known as plaque. Nerve fibres (axons) eventually degenerate; there is a loss of
impulse transmission, & focal deficits occur which in some instances may be permanent. This gentleman has been admitted to hospital suffering from muscular pain and elimination problems. Due to the distress these can cause they should dealt with as a matter of urgency.
The nursing priorities and management for this patient include;
COMMUNICATION
- to provide psychological support and reassurance to patient/family explaining what is happening and that everything that can be done is being done (to relieve patient/family anxiety)
- if patient has problems communicating as can be the case with multiple sclerosis sometimes then picture charts can be used to allow the patient to point out what they mean.
PAIN (BRIEF ASSESSMENT)
- to carry out a pain assessment to determine patients level of pain ie mild, moderate or severe by using a pain score chart. (if patient has problems communicating as can be the case with multiple sclerosis sometimes then picture charts can be used to allow the patient to point out what they mean).
- to determine allergies then contact doctor for prescription of analgesia for the patient.
- to administer prescribed analgesia and monitor patient through observing patient body language and regular pain scoring.
- & by measuring and recording vital signs ie blood pressure, temperature, pulse, respirations (explain + normal ranges) document these and report any abnormalities to medical team.
ELIMINATION
-
FULL ASSESSMENT
- to determine; how much patient/family understand about multiple sclerosis/
- to determine the patient's coping strategies;
- their degree of independence in activities of living.
- to draw up a care plan and initiate the discharge plan.
- to work cooperatively involving necessary members of the multi discplinary team in the care plan for example the physiotherapist to teach simple exercises to relieve muscle stiffness, dietician to help relieve symptoms associated with elimination problems.
This gentleman has been having problems eliminating. Problems such as incontinence, urinary frequency, urinary retention and constipation are cause for concern. The urinary problems occur as a result of the reflex action of the bladder being disturbed due to sites of demyelination in the lower spine. The nurse may be required to catheterise this patient if persistent urinary retention is experienced. However, the option of self-catheterisation should be explained to this man including the need for adequate hygiene to avoid infection. Advice from a continence advisor may also be useful.
PATIENT/FAMILY EDUCATION
the availability of further counselling and advanced psychological support
should be offered to this patient to help with handling difficult issues such as the deterioration in their condition. Nursing staff must encourage the patient to continue being as independent as his condition allows.