Week 6: Neurologic and Musculoskeletal Disorders
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?
This week, you will evaluate patients for the treatment of neurologic and musculoskeletal disorders by focusing on specific patient case studies through a decision tree exercise. You will analyze the decisions you will make in the decision tree exercise and reflect on your experiences in proposing the recommended actions to address the health needs in the patient case study.
Learning Objectives
Students will:
Evaluate patients for treatment of neurologic and musculoskeletal disorders
Analyze decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders
Justify decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders
Learning Resources
Required Readings (click to expand/reduce)
Required Media (click to expand/reduce)
Assignment: Decision Tree for Neurological and Musculoskeletal Disorders
For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.
Photo Credit: Getty Images/Science Photo Library RF
To Prepare
Review the interactive media piece assigned by your Instructor.
Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.
By Day 7 of Week 8
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.
You will submit this Assignment in Week 8.
Sample Answer
Neurologic and Musculoskeletal Disorders
The case study examines the treatment of Sabrina, a 26-year-old female with multiple sclerosis. The treatment is meant to address the neurologic and musculoskeletal disorders occurring as a result of multiple sclerosis. The first decision is to prescribe dimethyl fumarate 50 mg daily. The second decision is to increase the dosage to 120mg daily while the third decision is to increase the dosage to 240 mg daily.
The decisions are supported by evidence-based practice since dimethyl fumarate is used in the treatment of multiple sclerosis by blocking immune cells from damaging nerves (Gajofatto & Benedetti, 2015). It also functions as an antioxidant to protect the brain and spinal cord. The drugs are necessary for preventing relapse and severe symptoms that trigger neurologic and musculoskeletal disorders.
In the first decision of prescribing dimethyl fumarate 50 mg daily, I was hoping to reduce the rate of relapse and reduce symptoms associated with neurologic and musculoskeletal disorders such as poor cognition, muscle weakness, and seizures (Cerqueira et al., 2018). In the second decision of prescribing dimethyl fumarate 120mg daily, I was hoping to reduce symptoms including poor cognition, muscle weakness, and seizures (Gandhi et al., 2016). In the third decision of prescribing dimethyl fumarate 240 mg daily, I was hoping to reduce the symptoms (Gandhi et al., 2016). The drug is necessary to decrease the worsening condition of multiple sclerosis.
In the first prescription of dimethyl fumarate 50 mg daily the patient still experienced the same disorders with no health improvement, which was against my expectation. When the medication was increased to 120mg daily the patient reported a mild decrease in the symptoms, which was as per my expectation. When it was increased to 240mg the patient-reported decrease of symptoms and significant health improvement as per my expectation.
References
Cerqueira, J. J., Compston, D. A. S., Geraldes, R., Rosa, M. M., Schmierer, K., Thompson, A., … & Palace, J. (2018). Time matters in multiple sclerosis: early treatment and long-term follow-up ensure everyone benefits from the latest advances in multiple sclerosis? J Neurol Neurosurg Psychiatry, 89(8), 844-850.
Gajofatto, A., & Benedetti, M. D. (2015). Treatment strategies for multiple sclerosis: when to start, when to change, when to stop? World Journal of Clinical Cases: WJCC, 3(7), 545.
Gandhi, S., Jakimovski, D., Ahmed, R., Hojnacki, D., Kolb, C., Weinstock-Guttman, B., & Zivadinov, R. (2016). Use of natalizumab in multiple sclerosis: current perspectives. Expert Opinion on Biological Therapy, 16(9), 1151-1162.
