Posted: April 27th, 2023

Sabrina is a 26 year old female

Sabrina is a 26 year old female who has just been diagnosed with multiple sclerosis. She has scheduled an appointment for a follow up with her physician but has several questions about her diagnosis and is calling the Nurse Helpline for her hospital network. As she talks with the advanced practice nurse, she learns that her diagnosis also impacts her neurologic and musculoskeletal systems. Although multiple sclerosis is an autoimmune disorder, both the neurologic and musculoskeletal systems will be affected by adverse symptoms that Sabrina needs to be aware of and for which specific drug therapy plans and other treatment options need to be decided on.
As an advanced practice nurse, what types of drugs will best address potential neurologic and musculoskeletal symptoms Sabrina might experience?

Write a 1- to 2-page summary paper that addresses the following:
• Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
• Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
• What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
• Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

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Introduction

Multiple sclerosis (MS) is an autoimmune disorder that affects the central nervous system (CNS) by damaging the myelin sheath surrounding the neurons. The disease is characterized by a wide range of neurological and musculoskeletal symptoms, which can significantly impact the patient's quality of life. In this case study, Sabrina, a 26-year-old female, has been diagnosed with MS and is seeking advice on the potential symptoms and drug therapies that can help manage them.

Patient Case Study

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Sabrina is a 26-year-old female who has been diagnosed with MS. She has concerns about the potential neurological and musculoskeletal symptoms that may arise as a result of the disease. As an advanced practice nurse, I recommended the following decisions for Sabrina:

Medication Therapy: I recommended that Sabrina be started on disease-modifying therapies (DMTs) to help reduce the frequency and severity of MS relapses. Some of the DMTs that have been shown to be effective in managing MS include interferon-beta, glatiramer acetate, dimethyl fumarate, and fingolimod.

Symptomatic Treatment: I recommended that Sabrina be prescribed medications to manage her specific symptoms. For example, muscle spasms and spasticity can be managed with baclofen, tizanidine, or dantrolene. Pain can be managed with nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or opioids.

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Physical Therapy: I recommended that Sabrina undergo physical therapy to help manage her musculoskeletal symptoms. Physical therapy can help improve muscle strength, flexibility, and balance, which can improve her overall mobility and reduce the risk of falls.

Evidence-Based Literature

The decisions that I recommended for Sabrina are supported by the evidence-based literature. Several studies have demonstrated the efficacy of DMTs in reducing MS relapses and slowing down disease progression (Lublin et al., 2014; Ontaneda & Fox, 2015). Similarly, medications such as baclofen and tizanidine have been shown to be effective in managing muscle spasms and spasticity (Bhattacharyya et al., 2015; Flachenecker et al., 2014). Finally, physical therapy has been shown to improve muscle strength, balance, and overall mobility in MS patients (Kargarfard et al., 2012; Rasova et al., 2011).

Expected Outcomes

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The decisions that I recommended for Sabrina were aimed at reducing the frequency and severity of MS relapses, managing her specific symptoms, and improving her overall mobility and quality of life. I expected that Sabrina would experience a reduction in the number and severity of her relapses, as well as a reduction in her musculoskeletal symptoms. I also expected that physical therapy would improve her overall mobility and reduce the risk of falls.

Conclusion

MS is a complex disease that can have a significant impact on a patient's neurological and musculoskeletal systems. The decisions that I recommended for Sabrina, including medication therapy, symptomatic treatment, and physical therapy, are supported by the evidence-based literature and are aimed at managing her specific symptoms and improving her overall quality of life.

References:

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Bhattacharyya, S., Darby, R. R., Raibagkar, P., & Gonzales, C. (2015). Musculoskeletal complications of multiple sclerosis. Neurology Clinical Practice, 5(2), 135-142.

Flachenecker, P., Henze, T., & Zettl, U. K. (2014). Spasticity in patients with multiple sclerosis—clinical characteristics, treatment and quality of life. Acta Neurologica Scandinav

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