1. MULTIPLE SCLEROSIS DISEASE MANAGEMENT

2. Introduction of Case Study
In this case the person is multiple Sclerosis patient. She is about 34 years of age.
Patient feels that her left body portion is relatively weak, massive fatigue with a potential Lhermitte’s symptoms.
After experiencing a mal seizure in the office she is taken in to the Emergency Department.
MRI was conducted to identify the exact reason for seizure.
Frequent diagnosis schedule with neurologist.
Our patient is female and she passed twelve years of married life bearing two children. Multiple sclerosis causes demyelination of the nerves of the Central Nervous System. Patient feels that her left body portion is relatively weak, massive fatigue with a potential Lhermitte’s symptoms. Multiple Sclerosis is basically an autoimmune disease and it cause complicated medical problems. After experiencing a mal seizure in the office patient is taken in to the Emergency Department. After diagnosis patient is found with a bruise in her left side of the face. Furthermore to prevent consecutive seizure in the emergency room doctors give her 25mg Dilantin and 75mg Valium. MRI was conducted to identify the exact reason for seizure. She has some malfunctioning in the temporal lobe which caused her minor mal seizure in her young age.

3. Case Study, Continued
MRI results revealed that there are at least eleven spots where myelin sheath of the nerves is deteriorated. Myelin sheath is vital for the nerves and it acts like an insulator of the nerve. Demyelination cause poor nerve transmission.
It is believed that multiple sclerosis is a genetic disease. However, viral infection and auto immune response can cause this disease as well.
Different medications such as Neurontin 200mg, TID, Baclofen 10mg, and Ritalin are prescribed to the patient.
MRI results revealed that there are at least eleven spots where myelin sheath of the nerves is deteriorated. Myelin sheath is vital for the nerves and it acts like an insulator of the nerve. Demyelination cause poor nerve transmission. It is believed that multiple sclerosis is a genetic disease. However, viral infection and auto immune response can cause this disease as well. Due to some unknown reasons WBC or white blood cells of the nervous system treat myelin as a unknown or foreign particle. They actually attack myelin that creates break down of myelin sheath thus causing Multiple Sclerosis. Several medications are actually prescribed to the patient that is targeting to alleviate different issues. For instance, Neurontin 200mg, Tegretol 300mg, BID is prescribed to control seizure; Baclofen 10mg, QHS is prescribed to prevent muscle spasm and TID is for preventing the symptoms of fatigue.

4. Incidence and Economic Effects
Throughout the years of :
288,454 patients admitted to hospital for diagnosis of Multiple Sclerosis.
Average cost ranges from 7,965 to 20,076 dollars for each patient.
A significant change in home health from 8.6% to 14.9%.
Average staying in the hospital lessens from 6.9 days to 4.9 days.
As an outcome of this disease Nursing homes & Rehabilitation Centers increased from 8.3% to 22.6%
In the year of 2006 Multiple Sclerosis was the major non-traumatic neurological handicap among the young people in USA and in numbers it was 350,000 individuals.
A statistical analysis was done from the year of 1993 to 2006 and some significant facts were revealed. Within this time period 288,454 patients were admitted to hospital for primary diagnosis. Average cost ranges from 7,965 to 20,076 dollars for each patient. Home health exceeded 8.6 to 14.9 percent. Utilization of Rehabilitation centers and Nursing home increased by 14.3% from Average staying in the hospital lessens from 6.9 days to 4.9 days however, at present it is about five days. In the year of 2006 Multiple Sclerosis was the major non-traumatic neurological handicap among the young people in USA and in numbers it was 350,000 individuals.

5. Presentation of MS Some less common symptoms Problems in swallowing
Most common symptoms of MS are:
Some less common symptoms
Numbness
Fatigue
Coordination & balancing problems
Malfunctioning of bowel and bladder
Severe pain
Sexual malfunction
Cognitive dysfunction
Depression
Emotional changes
Problems in swallowing
Speech disorder
Loss of hearing
Headache
Tremor
Seizures
Itching
Breathing and respiratory complication
Symptoms of MS are diversified. It actually depends on the occurrence of the lesions and thus it is really hard to diagnose. This disease actually affects the people whose age ranges from twenty to forty. According to the National Multiple Sclerosis Society MS have four courses of action. These courses have their own mild, moderate or severe action.
Relapsing-Remitting MS: This course of MS has distinctive attack which seriously damages neurologic function which includes relapses or exacerbation. Mainly these occur when the disease is in partial or complete recovery stage and thus disease progression seize. About 85% people are affected by this.
Primary-progressive MS: This is rather slow course of action of MS and it slowly but surely damages the neurological function. It is not characterized by relapses or remissions. About 10% people are affected by this course.
Secondary-progressive MS: This course, if it occurs usually seen after the initial attack of relapsing-remitting MS. In this course the disease develop badly even more slowly. Occasional flare-ups, minor recoveries or plateaus may or may not be seen. About 50% people with relapsing remitting MS are affected by this prior to the availability of disease modifying medications.
Progressive-Relapsing MS: This course has very rare occurrence frequency and only 5% people are affected with this. This course of MS continues without any sign of remissions.
Because all the courses have different symptoms which vary greatly from person to person it is really difficult for the doctors to identify straight away which course you are experiencing.

6. Socio-cultural Needs
Healthy way of living should be the goal for the people who are affected with multiple sclerosis.
Developing healthy relationship
Make a chase for achieving career and educational goal.
Maintain a healthy lifestyle during the periods of provocation.
Enlisting support
Recall of spiritual needs in your life.
Planning for the future.
Even in the time of severe illness physical, emotional and spiritual well being can be achieved by the dynamism of mind. If you are a patient of MS and you want to recover then only medication or treatment is never sufficient. It requires more. Satisfying your demands, spending a joyous leisure, a standard meaningful place in the society and above all full concentration to meet up your inner want are equally vital in the recovering stage of MS.

7. Multiple Sclerosis Therapies
Conventional Therapies:
Beta-interferon therapy minimize exacerbations
Steroids: Reduce inflammation
Anticonvulsants: Relieves a person from nerve pain
Immunosuppressant’s: Dispirit the immune system
Muscle Relaxants: It’s a great aid in controlling muscle spasm
Parasympathetic: Almost eliminate bladder complications.
It’s an amazing thing that many MS patients do a great deal without any medication. However, treatments with Interferon like Betaseron or Avonex minimize exacerbation and thus prolong the handicap state. Some steroids such as Adrenocorticotrophic Hormone reduce sores or edema of the neuron. Azathioprine and cyclophosphamide are some of the immunosuppressant that dispirits the immune system. MS sometimes causes severe nerve pain to its patient and to relieve the patient from this pathetic pain several anticonvulsants like phenytoin, carbamazipine can be applied. Prescribed physical therapy can control muscle spasm to some extent. Bladder complications may be eliminated by parasympathetic agents.

8. Multiple Sclerosis Therapies
Complementary and Alternative Therapies:
Choose fiber rich and low fat diet.
Make an habit of regular exercise
Avoid stress
Acupuncture is helpful against a verities of problems
Concentrate on vitamins.
Food- Fiber rich and low fat diet certainly control and in some cases can even cure MS. However, keep in mind that foods are never be able to alternate the course of MS. Doctors always suggest that we should always include fiber rich as well as low fat item in our dietary menu.
Exercise- Several forms of exercises such as aerobic exercise, stretching exercise can help the people with MS in various ways. It not only improves your overall health but also removes fatigue, bladder and bowel malfunctioning as well as minimize stiffness. Regular exercise can increase your abilities to great extent.
Stress- Stress is the other name of various complications. Stress is also very harmful for the patient of MS. Different people have different level of stress taking ability but it is always true that none of us want to embrace stress in our life. So it is your duty to identify the perfect stress management strategy that suits the best for you.
Acupuncture- Acupuncture is slowly but surely making its place into the market of Western medicine. It is doing so with its proof of usefulness against a wide range of complications.
Vitamins- We can get vitamins from our food although vitamin D is an exception. Antioxidant vitamins, vitamin B6 and B12 are particularly beneficial to the patient of MS.

9. Potential Learning Needs
Determine:
Patient’s readiness to learn: Consider the cues that the patient is inquiring regarding MS when he is in the worst stage of symptoms. Keep in mind that different individual is in different stages of readiness.
Preferred style of learning: Learning can take place by audio, video or touch. All of these methods have their own benefits and limitations.
Never think that the topics you are giving emphasis will be of the same priority to the patient. He or she might have different choices. Ask patients what topics they would like to begin with.
Language understanding problem, impaired memory, physical disabilities, lack of knowledge on that particular field, impaired hearing or sight could be barriers of learning.
When you want to determine the readiness of the patient take in to account, the cue about MS. You may also get some feedback about what they need to know simply by asking questions to them. While at progressive worsening stage of the disease different individuals have different level of readiness so it is your duty to mold your educational approach according to the level of the targeted patient. Patients may prefer auditory, visual or tactile learning style depending on their mood. There are several aspects about MS that a person need to learn and usually patients express their priority what they want to learn first. After knowing the priority you can give emphasis on them take a video teaching approach and thus make your learning more beneficial. If the patient or family members disagree with the healthcare provider at that point the educator must start consultation to bring congruence among them. Learning can be hampered with the presence of learning disabilities, language problem, low literacy level, impaired memory, impaired hearing, sight or even the patient emotion at that time. These are commonly known as barrier of learning. These barriers can be removed by proper counseling with the patient and this should be done on an ongoing basis.

10. Teaching Strategies
Various learning or teaching strategies can be used.
Direct instruction, written instruction, internet and other technology based methods, group training are the significant ones.
Integration of different activities which include specific personal instruction and other personal involvement can be the most effective learning strategy.
There are a numbers of patient and their family members who remain preoccupied with the diagnosis of MS. So they are subdued with clinical care complications and with direct, specific questions asked by the nurse. At this stage numbers of different learning and motivational strategies can be applied to give support to the patient education. Some of the significant strategies include direct information, written instructions, technology based method such as using internet etc. So far the most effective strategy involves integration of activities which include specified instruction and personal level engagement by the medical specialist.

11. More Teaching Strategies
Patients get information as well as medical care from several clinical settings:
This process generally starts in a physician’s chamber. Consistency of information is necessary.
Information is offered by healthcare professionals.
Multiple sclerosis has several symptoms and they are actually unpredictable.
Patient’s education with MS typically starts form doctor’s chamber. It may also start during inpatient setting. Moreover, outpatient primary care, rehabilitation centers and specialty clinics have good potential to start education from there. Once you start giving the information it should be consistent throughout the disease life cycle. Educators of Multiple Sclerosis include doctors, physical therapists, nurses and pharmacists. Except these people the education program should not be delegated to other clinical staff. Educators who actually can modify the information according to the needs of the patient are treated as the most successful one. Healthcare professionals also support the patient both mentally and physically to cope up with the difficulties of living with MS. Sign and symptoms of MS is not stable or constant rather it varies from person to person. Numbness, fatigue, coordination problem, motor malfunction, spasticity, pain, bowel and bladder dysfunction, vertigo and sexual malfunctioning are some of the symptoms of Multiple Sclerosis.

12. References
Engelke, Z. (2011). Patient Education: Teaching the Patient with Multiple Sclerosis. CINAHL Nursing Guide. Retrieved from EBSCOhost.
Lad, S.P., Chapman, C.H., Vaninetti, M., Steinman, L., Green, A. & Boakye, M. (2010, August). Socioeconomic Trends in Hospitalization for Multiple Sclerosis. Neuroepidemiology, 35(2), Electronic Publication 2010, June 15, EBSCOhost.
National Multiple Sclerosis Society. (2011). Complementary & Alternative Medicine. Retrieved fromhttp://
Neighbors, M. & Tannehill-Jones, R. (2006). Human Diseases (2nd ed.). Clifton Park, NY: Thomas-Delmar Learning.
Williams, L. S. & Hopper, P. D. (2007). Understanding medical surgical nursing (3rd ed.). Philadelphia, PA: F. A. Davis.