Group 38 Case

DAVAO DOCTORS COLLEGE, INC.
General Malvar St., Davao City

College of Allied Health Sciences | Nursing Program
MULTIPLE SCLEROSIS
A Case Study Presented to the Nursing Clinical Instructors

of Davao Doctors College, Inc.
In Partial Fulfillment of the Requirements in

In Partial Fulfilment of the Requirements in NRG301: Care of Clients with Problems in Oxygenation,
Fluid and Electrolytes, Infections, Inflammatory and Immunologic, Cellular Aberrations, Acute and
Chronic
Members:
Capiloyan, Rfyza D., Caspillo, Maria Krichelle B., Chatto, Princess Grace P.,
Dedal, Nesslie C., Diamante, Leah Dennesse D., Ebo, Melwin Jay E.,
Escovilla, Martina Roselle, Ferolin, James Michael,
Indo, Keth Laurence
November 2023
TABLE OF CONTENTS
I. Objectives……………………………………………………………………………3
II. Introduction ……………………………………………………………………… 5
III. Patient’s Profile…………………………………………………………………… 7
i. Biographic Data……………………………………………………………..7
ii. Clinical Data………………………………………………………………...7
iii. Past Health History………………………………………………………….8
iv. Present Health History………………………………………………………9
v. Family History with Genogram…………………………………………….10
IV. Review of Anatomy and Physiology…………………………………………… 11
V. Pathophysiology………………………………………………………………… 20
i. Definition of Diagnosis…………………………………………………… 20
ii. Etiology…………………………………………………………………… 23
iii. Symptomatology……………………………………………………………25
iv. Schematic Diagram…………………………………………………………27
v. Narrative……………………………………………………………………28
VI. Comprehensive Assessment………………………………………………………30
VII. Course in the Ward/Treatment/Interventions………………………………… 38
i. Medical Management………………………………………………………38
1. Doctor’s Progress Notes……………………………………………… 38
2. Laboratory/Diagnostic Examinations………………………………… 41
3. Pharmacological Management…………………………………………43
ii. Nursing Management……………………………………………………… 59
1. Nursing Care Plan………………………………………………………59
2. Discharge Plan………………………………………………………… 69
VIII. Bibliography……………………………………………………………………… 71
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CHAPTER 1
OBJECTIVES
General Objectives
The general objective of the Bachelor of Science in Nursing, Level 3 Section J - Group 38,
must accomplish this virtual case study within the allotted time given on the online platform of
Davao Doctors College. The group will create an in-depth case study on the chosen subject who
takes part and learn how their general health is progressing after proper patient education and
interventions to promote optimal well-being. Our knowledge and abilities in implementing an
appropriate and effective Nursing Process approach would be improved.
Specific Objectives
Our group has formulated the following objectives to help us complete this case study as follow:
a. Create an introduction that provides a brief overview of the case study;
b. Collect data regarding the complete profile of the patient to establish relevant baseline data
for reference;
c. Develop specific, measurable, attainable, realistic, and time-bound (SMART) objectives to
serve as a guide for the completion of this study;
d. Investigate and explain the significance of diagnostic tests;
e. Present the review of the anatomy and physiology of the clients' affected system;
f. Research on the drug study of the medication given to our patient;
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g. Enumerate the actual and possible medical and nursing management rendered;
h. Create effective nursing care plans and discharge plans for clients based on their condition
and health needs, using appropriate nursing interventions
i. Provide significant health education to our patients to promote their health and wellness;
and
j. Make a list of all the references used in the study.
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CHAPTER II
INTRODUCTION
Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord
(central nervous system). In MS, the immune system attacks the protective sheath (myelin) that
covers nerve fibers and causes communication problems between your brain and the rest of your
body. Eventually, the disease can cause permanent damage or deterioration of the nerve fibers.
According to Ignacio et al., (2020), (Worldwide, multiple sclerosis (MS) is the most
common inflammatory neurological disease in young adults. The 2019 study on the burden of MS
from 1990-2016 reported 2.2 million prevalent cases of MS globally (GBD 2016 Multiple
Sclerosis Collaborators, 2016). The prevalence and incidence of the disease has increased
substantially in many regions since 1990 (GBD 2016 Multiple Sclerosis Collaborators, 2016). The
Philippines is among these countries with a reported 27.8% percentage change in age-standardized
rates of MS between 1990 and 2016. This was higher than the global prevalence change of 10.4%
(GBD 2016 Multiple Sclerosis Collaborators, 2016).
A case study conducted by Montojo et al., (2022), in Davao city, statistical data about the
MS prevalence is absent based upon research. But it is stated by the Philippine Rheumatology
Association (2016) that Davao City has seven rheumatologists to attend to musculoskeletal and
rheumatic conditions of patients.
We, the student nurses from BSN3-13J-Group 38 of Davao Doctors College, Inc., have
been granted the opportunity to analyze a case involving a patient diagnosed with Multiple
Sclerosis. This case study allows us to apply our theoretical knowledge from classroom and online
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lectures, enhancing our skills and potentially contributing to advancements in nursing practice,
education, and research. The insights gained from examining this case could be a valuable resource
for both current and future nursing students, as well as clinical instructors, providing a detailed
exploration of multiple sclerosis and its associated care. We aim to create a comprehensive and
informative resource that can supplement existing studies in nursing education.
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CHAPTER III
PATIENT'S PROFILE
I. Biographic Data
Patient’s Name : Napoles, Angeline
Age : 39 year old
Gender : Female
Birthday : April 29, 1984
Weight : 54 kgs.
Height : 5’2
Civil Status : Married
Birth Place : Mati, Davao Oriental
Address : Apokon, Tagum City, Davao del Norte
Religion : Catholic
Nationality : Filipino
Occupation : Private Nurse
II. Clinical Data
Chief Complaint : Numbness of lower extremities

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Date of Admission : October 23, 2023
Time of Admission : 9:15 AM
Hospital : Davao Doctors Hospital
Room number : 3016
Attending Physician : Dr. Demegillo
VITAL SIGNS UPON ADMISSION RESULTS
Temperature 36.4 °C
Pulse Rate 87 bpm
Respiratory Rate 20 cpm
Blood Pressure 120/80 mmHg
Oxygen Saturation 97%
Pain Scale 8/10
III. Past Health History
The patient had no significant medical procedures related to MS in the past 12 months.
There are occasional relapses with various sensory symptoms, mostly affecting lower extremities.
No known drug allergies. The patient uses tobacco regularly. Family history reveals that the
patient’s father had a history of hypertension and diabetes and the patient’s mother had multiple
sclerosis.
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IV. Present Health History
Prior to admission, a 39-year-old female was rushed to the hospital due to numbness of
pain in lower extremities. She described the numbness as a constant sensation, and rated the pain
intensity at 8/10 on the pain scale. She reported that she first started noticing symptoms about the
past week and has been feeling progressively worse.
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V. Genogram
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CHAPTER IV
REVIEW OF ANATOMY AND PHYSIOLOGY
The central nervous system (CNS) is made up of the brain and spinal cord. The brain
controls most body functions, including awareness, movements, sensations, thoughts, speech and
memory. The spinal cord is connected to the brain at the brain stem and is covered by the vertebrae
of the spine. Nerves exit the spinal cord to both sides of the body. The spinal cord carries signals
back and forth between the brain and the nerves in the rest of the body.
The peripheral nervous system (PNS) is the part of the nervous system outside of the
CNS. It is made up of nerves and ganglia that send signals to and receive signals from the CNS.
The PNS is divided into the somatic nervous system and the autonomic nervous system. The
somatic nervous system controls body movements that are under our control such as walking. The
autonomic nervous system controls involuntary functions that the body does on its own such as
breathing and digestion.
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Cerebral cortex: The cerebral cortex is the outermost layer that surrounds the brain. It is
composed of gray matter and filled with billions of neurons used to conduct high-level executive
functions. The cortex divides into four lobes; frontal, parietal, occipital, and temporal by different
sulci. The frontal lobe, located anteriorly to the central sulcus, is responsible for voluntary motor
function, problem-solving, attention, memory, and language. Located in the frontal lobe are the
motor cortex and the Broca area. The motor cortex allows for the precise voluntary movements of
our skeletal muscles, while the Broca area controls motor functions responsible for producing
language. The parietal lobe is separated from the occipital lobe by the parieto-occipital sulcus and
is behind the central sulcus. It is responsible for processing sensory information and contains the
somatosensory cortex. Neurons in the parietal lobe receive information from sensory and
proprioceptors throughout the body, process the can, and form an understanding about what is
being touched based on previous knowledge. The occipital lobe, known as the visual processing
center, contains the visual cortex. Similar to the parietal lobe, the occipital lobe receives
information from the retina and then uses past visual experiences to interpret and recognize the
stimuli. Lastly, the temporal lobe processes auditory stimuli through the auditory cortex.
Mechanoreceptors located in the hair cells lining the cochlea are activated by sound energy, which
in turn sends impulses to the auditory cortex. The impulse is processed and stored based on
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previous experiences. The Wernicke area is in the temporal lobe and functions in speech
comprehension.
Basal nuclei: The basal nuclei, also known as basal ganglia, is located deep within the
cerebral white matter and is composed of the caudate nucleus, putamen, and globus pallidus. These
structures form the pallidum and striatum. The basal ganglia are responsible for muscle movements
and coordination.
Thalamus: The thalamus is the relay center of the brain. It receives afferent impulses from
sensory receptors located throughout the body and processes the information for distribution to the
appropriate cortical area. It is also responsible for regulating consciousness and sleep.
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Hypothalamus: While the hypothalamus is one of the smallest parts of the brain, it is vital
to maintaining homeostasis. The hypothalamus connects the central nervous system to the
endocrine system. It is responsible for heart rate, blood pressure, appetite, thirst, temperature, and
the release of various hormones. The hypothalamus also communicates with the pituitary gland to
release or inhibit antidiuretic hormone, corticotropin-releasing hormone, gonadotropin-releasing
hormone, growth hormone-releasing hormone, prolactin inhibiting hormone, thyroid releasing
hormone, and oxytocin.
Pons: Found in the brainstem, the pons connects the medulla oblongata and the thalamus.
It is composed of tracts responsible for relaying impulses from the motor cortex to the cerebellum,
medulla, and thalamus.
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Medulla oblongata: The medulla oblongata is at the bottom of the brain stem, where the
spinal cord meets the foramen magnum of the skull. It is responsible for autonomic functions,
some of which are crucial for survival. The medulla oblongata monitors the bodies respiratory
system using chemoreceptors. These receptors are able to detect changes in blood chemistry. For
example, if the blood is too acidic, the medulla oblongata will increase the respiratory rate allowing
for more oxygen to reach the blood. It is also a cardiovascular and vasomotor center. The medulla
oblongata can regulate the body's blood pressure, pulse, and cardiac contractions based on the
body’s needs. Lastly, it controls reflexes like vomiting, swallowing, coughing, and sneezing.
Cerebellum: The cerebellum, also known as the little brain, is responsible for smooth,
coordinated voluntary movements. It subdivides into three lobes: the anterior, posterior, and
flocculonodular lobes. The cerebellum contains a cerebellar circuit, using Purkinje cells and
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cerebellar peduncles to communicate to other parts of the brain. The superior cerebellar peduncle
is composed of white matter that connects the cerebellum to the midbrain and allows for
coordination in the arms and legs. The inferior cerebellar peduncle connects the medulla and
cerebellum using proprioceptors to maintain balance and posture. Lastly, the middle cerebellar
peduncle is used as a one-way communication method from the pons to the cerebellum. It is mostly
composed of afferent fibers that alert the cerebellum about voluntary motor actions. The
cerebellum is in constant communication with the cerebral cortex, taking higher-level instructions
about the brain’s intentions, processing them through the cerebellar cortex, then sending messages
to the cerebral motor cortex to make voluntary muscle contractions. These contractions are
calculated to determine the force, direction, and momentum necessary to ensure each contraction
is smooth and coordinated.
Limbic System: The limbic system is composed of the piriform cortex, hippocampus,
septal nuclei, amygdala, nucleus accumbens, hypothalamus, and anterior nuclei of the thalamus.
The fornix and fiber tracts connect the limbic system parts allowing them to control emotion,
memory, and motivation. The piriform cortex is part of the olfactory system and is in the cortical
area of the limbic system. The hypothalamus receives most of the limbic output, which explains
psychosomatic illnesses, where emotional stressors cause somatic symptoms. For example, a
patient who is currently having financial struggles might present to his primary care physician with
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hypertension and tachycardia. The septal nuclei, amygdala, and nucleus accumbens are found in
the subcortical areas and are responsible for pleasure, emotional processing, and addiction,
respectively.
Reticular formation: Reticular formation is an extensive network of pathways containing
neurons that begins in the brainstem and travels from the top of the midbrain to the medulla
oblongata. These pathways project reticular neurons that affect the cerebral cortex, cerebellum,
thalamus, hypothalamus, and spinal cord. The reticular formation controls the body's level of
consciousness through the reticular activation system, also known as RAS. Sensory axons, found
in visual, auditory, and sensory impulses, activate RAS neurons in the brain stem. These neurons
then relay information to the thalamus and cerebrum. Continuous stimulation of the RAS neurons
causes the cerebrum to stay in an aroused state; this gives the feeling of alertness. However, RAS
can filter out repetitive, weak stimuli; this prevents the brain from responding to unimportant
information, as well as being sensory overloaded.
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Spinal cord: The spinal cord proper extends from the foramen magnum of the skull to the
first or second lumbar vertebrae. It creates a two-way pathway between the brain and the body and
divides into four regions - cervical, thoracic, lumbar, and sacral. These regions are then broken
down into 31 segments with 31 pairs of spinal nerves. There are 8 cervical nerves, 12 thoracic
nerves, 5 lumbar nerves, 5 sacral nerves, and 1 coccygeal nerve. Each nerve exits the vertebral
column passing through the intervertebral foramina and to its designated location in the body.
Due to cervical and lumbar enlargements, the spinal cord differs in width throughout its
structure. The cervical enlargement occurs at C3 to T1, and the lumbar enlargement is at L1 to S2.
The white matter is present on the outside of the spinal cord, with gray matter located in its core
and cerebrospinal fluid in the central canal. The gray commissure, the dorsal, lateral, and ventral
horns are all composed of gray matter. The gray commissure surrounds the central canal. The
dorsal horns are made of interneurons, while the ventral horns are somatic motor neurons. Afferent
neurons in the dorsal roots carry impulses from the body’s sensory receptors to the spinal cord,
where the information begins to be processed. The ventral horns contain efferent motor neurons,
which control the body's periphery. The axons of motor neurons are found in the body's skeletal
and smooth muscle to regulate both involuntary and voluntary reflexes.
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The spinal cord ends in a cone-shaped structure called conus medullaris and is supported to the
end of the coccyx by the filum terminale. Ligaments are found throughout the spinal column,
securing the spinal cord from top to bottom.
Ascending pathway to the brain: Sensory information travels from the body to the spinal
cord before reaching the brain. This information ascends upwards using first, second, and third-
order neurons. First-order neurons receive impulses from skin and proprioceptors and send them
to the spinal cord. They then synapse with second-order neurons. Second-order neurons live in the
dorsal horn and send impulses to the thalamus and cerebellum. Lastly, third-order neurons pick up
these impulses in the thalamus and relay it to the somatosensory portion of the cerebrum.
Somatosensory sensations are pressure, pain, temperature, and the body's senses.
Descending pathway: Descending tracts send motor signals from the brain to lower motor
neurons. These efferents neurons then produce muscle movement.
The brain, a delicate nervous tissue organ, is responsible for responses, sensation,
movement, emotions, communication, thought processing, and memory. It is protected by the
skull, meninges, and cerebrospinal fluids, and has a blood-brain barrier to prevent harmful
substances from entering.
The spinal cord, located in the vertebral column, is crucial for transmitting motor
commands and transmitting sensory information from the brain to the peripheral body, protected
by bone, meninges, and cerebrospinal fluids.
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CHAPTER V
PATHOPHYSIOLOGY
I. Definition of Diagnosis
Localized areas of demyelination (plaques) occur, with destruction of oligodendroglia,
perivascular inflammation, and chemical changes in lipid and protein constituents of myelin in and
around the plaques. Axonal damage is common, and neuronal cell bodies may also die or be
damaged. Fibrous gliosis develops in plaques that are disseminated throughout the central nervous
system (CNS), primarily in white matter, particularly in the lateral and posterior columns
(especially in the cervical regions), optic nerves, and periventricular areas. Tracts in the midbrain,
pons, and cerebellum are also affected. Gray matter in the cerebrum and spinal cord can be affected
but to a much lesser degree.
Multiple sclerosis is characterized by varied CNS deficits, with remissions and recurring
exacerbations. When MS is not treated with immunomodulating medications, exacerbations
average about 1 every 2 years, but frequency varies greatly.
Although MS may progress and regress unpredictably, there are typical patterns of progression:
● Relapsing-remitting pattern: Exacerbations alternate with remissions, when partial or
full recovery occurs or symptoms are stable. Remissions may last months or years.
Exacerbations can occur spontaneously or can be triggered by an infection such as
influenza. Relapsing forms of MS include active secondary MS (defined as a clinical
relapse or new lesion seen on an MRI scan of the brain or spinal cord).
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● Primary progressive pattern: The disease progresses gradually with no remissions,
although there may be temporary plateaus during which the disease does not
progress. Unlike in the relapsing-remitting pattern, there are no clear exacerbations.
● Secondary progressive pattern: This pattern begins with relapses alternating with
remissions (relapsing-remitting pattern), followed by gradual progression of the
disease.
● Progressive relapsing pattern: The disease progresses gradually, but progression is
interrupted by sudden, clear relapses. This pattern is rare.
Other common early symptoms of MS include slight stiffness or unusual fatigability of a
limb, minor gait disturbances, vertigo, and mild affective disturbances; all usually indicate
scattered CNS involvement and may be subtle. Most patients with MS have difficulty with bladder
control (eg, frequency, urgency, hesitancy, incontinence, retention). Fatigue is common. Excess
heat (eg, warm weather, a hot bath, fever) may temporarily exacerbate symptoms and signs
(Uhthoff phenomenon). Mild cognitive symptoms are common. Apathy, poor judgment, or
inattention may occur. Affective disturbances, including emotional lability, euphoria, or, most
commonly, depression, are common. Depression may be reactive or partly due to cerebral lesions
of MS. A few patients have seizures.
Multiple sclerosis (MS) is a chronic inflammatory disease characterized by central nervous
system (CNS) lesions that can lead to severe physical or cognitive disability as well as neurological
defects. Although the etiology and pathogenesis of MS remains unclear, the present documents
illustrate that the cause of MS is multifactorial and include genetic predisposition together with
environmental factors such as exposure to infectious agents, vitamin deficiencies, and smoking.
These agents are able to trigger a cascade of events in the immune system which lead to neuronal
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cell death accompanied by nerve demyelination and neuronal dysfunction. Conventional therapies
for MS are based on the use of anti-inflammatory and immunomodulatory drugs, but these
treatments are not able to stop the destruction of nerve tissue. Thus, other strategies such as stem
cell transplantation have been proposed for the treatment of MS. Overall, it is important that
neurologists be aware of current information regarding the pathogenesis, etiology, diagnostic
criteria, and treatment of MS. Thus, this issue has been discussed according to recent available
information (Nazem Ghasemi 2016).
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II. Etiology
Precipitating Factors Present Justification
(✓)
Smoking Compared with nonsmokers, smokers may be twice as likely to be diagnosed
with MS and are more likely to be diagnosed with PPMS. Risk increases the
more that a person smokes. (Healthline 2021)
Obesity (x) Some research Trusted Source has found that having obesity in childhood or
adolescence increases MS risk. (Healthline 2021)
(x)
There’s evidence that some viruses, and maybe bacteria, can help trigger MS.
A common virus called Epstein Barr virus (it causes glandular fever) has been
Viral Infection linked to MS. Most people have had this virus but they never get MS. This
shows that, like genes, infections might play a role but they aren’t the whole
story. (MSSociety 2023)
(✓)
There’s more and more evidence that low levels of vitamin D, especially
before you become an adult, could be a factor in why people get MS. Our
Vitamin D deficiency skin makes most of our vitamin D when we’re out in the summer sun. We
also get some from food like oily fish, eggs, spreads and breakfast cereals
with added vitamin D in them. (Ms Society (MSSociety 2023)
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Predisposing Factors Present Justification
Most people with multiple sclerosis (MS) are

diagnosed between age 20 and 50, though it
Age: 39 year old (✓) can occur in children as well as in older
adults, according to the National Multiple
Sclerosis Society (NMSS 2020)
Females are at least 2 to 3 times more likely

to develop relapsing-remitting multiple
Gender: Female (✓) sclerosis (RRMS) than males, according to
the NMSS. Males and females develop
primary progressive (PPMS) at
approximately equal rates.( Healthline 2021)
Although MS is not a genetic disease, people

with a family history of the disease are more
likely to develop it. This suggests there may
be genetic factors predisposing people to
develop MS. Recent research has shown there
Family History (✓) may be more than 200 non-HLA single
nucleotide polymorphisms near genes
involved in adaptive or innate immunity that
also increase the risk of MS.5
(RareDiseaseAdvisor2021)
White people, particularly those of Northern

European descent, are at highest risk of
Race (x) developing MS. People of Asian, African or
Native American descent have the lowest
risk. A recent study suggests that the number
of Black and Hispanic young adults with
multiple sclerosis may be greater than
previously thought.( Mayo Clinic 2022)
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III. Symptomatology
Sign and Symptoms Present Justification
Feeling fatigued is one of the most common and

troublesome symptoms of MS. It's often described
as an overwhelming sense of exhaustion that means
it can be a struggle to carry out even the simplest
Fatigue (✓) activities. Fatigue can significantly interfere with
your daily activities and tends to get worse towards
the end of each day, in hot weather, after exercising,
or during illness. (NHS 2023
https://www.nhs.uk/conditions/multiple-
sclerosis/symptoms/)
Numbness and tingling are two of the most frequent

MS symptoms for which people seek medical care.
Numbness and tingling (x) They are part of a group of sensory symptoms called
paresthesias—abnormal sensations that cause
discomfort.(Julie Stachowiack 2023
https://www.verywellhealth.com/numbness-
tingling-in-ms-2440806)
Ongoing dizziness and vertigo may interfere with

daily tasks, increase your risk of falls, and even
Loss and balance and dizziness (✓) become disabling. Although they both have similar
and overlapping features, they’re two different
sensations. (Healthline 2023
https://www.healthline.com/health/multiple-
sclerosis/dizziness-vertigo#takeaway)
Muscle spasms and spasticity can have a big impact

on quality of life and daily activities for many
Stiffness or spasms (✓) people with MS. There are effective management
strategies, including drugs and other therapies,
which can help to maintain mobility and a pain-free
life. (MSTrust 2021 https://mstrust.org.uk/a-
z/spasticity-and-spasms)
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A tremor is when a body part moves or shakes and
you can’t control it. Many people with multiple
Tremor (✓) sclerosis (MS) have some form of tremor they can’t
control, in different parts of their bodies, like their
head, arms, or legs. (Paul Frysh, 2022
https://www.webmd.com/multiple-
sclerosis/managing-related-tremors)
Pain in MS can take many different and unusual

forms. It can be caused by direct nerve damage. Or
Pain (✓) it can come from your symptoms and strains they
Pain scale: 8/10 place on your body. (MSSociety, 2023
https://www.mssociety.org.uk/about-ms/signs-and-
symptoms/early-signs-of-ms)
Vision problems are common in people with MS

and are often the first sign of the disease before
diagnosis. Although vision problems can come on
suddenly and can have a big impact on almost every
Vision Problems (x) aspect of your daily life, they are often short-lived
and there are ways to manage them.
(TheMSResistance2021
https://themsresistance.com/ca-en/about-
ms/symptoms/vision.html)
Bladder dysfunction in multiple sclerosis (MS)

happens when lesions in the brain and/or spinal cord
disrupt nerve signals going to the detrusor muscle
(located in the wall of the bladder) and to the urinary
sphincter (muscles surrounding the opening to the
bladder). When the muscles of the bladder are not
Bladder Problems (✓) working correctly or in coordination with one
another, symptoms such as increased frequency
(having to go to the bathroom often), urgency
(having to go to the bathroom quickly), retaining
urine, and leaking urine, can occur. (MSAA 2023
https://mymsaa.org/ms-
information/symptoms/bladder-dysfunction/)
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IV. Schematic Diagram
Signs and symptoms Nursing Management

Precipitating Factors Predisposing Factors
• Fatigue • Educate patients and families about the nature
• Smoking • Age
• Sex • Numbness and tingling of MS, treatment options, and lifestyle
• Vitamin D deficiency
• Family History • Loss and balance and modifications to manage symptoms.
• Race dizziness • Coordinate care and referrals to
• Stiffness or spasms specialists, such as neurologists or rehabilitation
The immune system attacks the protective sheath (myelin) that • Tremor therapists.
• Pain • Monitor and manage potential
covers nerve fibers and causes communication problems
• Vision Problems complications, such as bladder or bowel
between your brain and the rest of your body.
• Bladder Problems dysfunction or cognitive changes.
The myelin is destroyed in many areas. This loss of myelin forms • Offer emotional support and counseling
scar tissue called sclerosis. These areas are also called plaques Diagnostic Tool to patients and families to cope with the impact
or lesions. When the nerves are damaged in this way, they can't • Magnetic resonance of MS.
conduct electrical impulses to and from the brain. imaging (MRI) • Schedule regular follow-up appointments to
• X-ray monitor disease progression, adjust treatment
Brain, Optic Nerves and Spinal • Thoracic APL plans, and address any concerns or changes in
symptoms.
If treated If not treated
Pharmacological Management
Corticosteroids, such as oral prednisone and
Good Prognosis Bad Prognosis
intravenous methylprednisolone, are prescribed
Most people with MS have a normal life expectancy, MS itself is rarely fatal, but complications may
to reduce nerve inflammation.
but a few patients with very severe disability may die arise from severe MS, such as chest or bladder
prematurely of infectious complications, such as infections, or swallowing difficulties. The average Surgical management
pneumonia, giving the overall life expectancy about life expectancy for people with MS is around 5 to
95% of a normal healthy individual. 10 years lower than average, and this gap appears Surgical procedures include deep brain
to be getting smaller all the time. stimulation, rhizotomy, and a baclofen pump.
LEGEND Opening blood flow is not recommended because
it is ineffective and may not be safe for people
FACTORS SIGNS AND SYMPTOMS MANAGEMENT with MS.
PROCESS DIAGNOSTIC TOOL PROGNOSIS
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V. Narrative
Multiple sclerosis (MS) is a chronic inflammatory and demyelinating autoimmune disease.
MS patients deal with motor and sensory impairments, visual disabilities, cognitive disorders, and
speech and language deficits. Predisposing factors includes the patient’s age, sex, family history
and race while the precipitating factors are smoking and Vitamin D deficiency. The disease is
characterized by the immune system mistakenly attacking the protective covering of nerve fibers,
called myelin, and causes communication problems between the brain and the rest of the body
resulting in inflammation and damage in the central nervous system by forming scar tissues called
sclerosis. These areas are also called plaques and lesions, when the nerves are damaged this way,
nerves can’t conduct electrical impulses to and from the brain. This affects the brain, optic nerves,
and spinal. Signs and symptoms include fatigue, numbness and tingling, loss of balance and
dizziness, stiffness or spasm, tremor pain, bladder problems, and vision problems.
The Magnetic Resonance Imaging (MRI) is the diagnostic tool used for diagnosing
Multiple sclerosis and tracks the progression of the disease. MRI scans confirm a diagnosis in over
90% of people with Multiple sclerosis. To get the image of your brain and spinal cord you will be
asked to lie down and enter a small tunnel in the center of the MRI scanner. Next X-ray is used to
look at the bones and joints, although they're sometimes used to detect problems affecting soft
tissue, such as internal organs. Lastly, the Thoracic Spine Anteroposterior is used to view images
of the thoracic spine, which consists of twelve vertebrae.
For the nursing management, first we will educate patients and families about the nature
of MS, treatment options, and lifestyle modifications to manage symptoms, coordinate care and
referrals to specialists, such as neurologists or rehabilitation therapists, monitor and manage
potential complications, such as bladder or bowel dysfunction or cognitive changes, offer
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emotional support and counseling to patients and families to cope with the impact of MS, and
schedule regular follow-up appointments to monitor disease progression, adjust treatment plans,
and address any concerns or changes in symptoms.
If treated, pharmacological Corticosteroids, such as oral prednisone and intravenous
methylprednisolone, are prescribed to reduce nerve inflammation. Surgical management will also
be used. Surgical procedures include deep brain stimulation, rhizotomy, and a baclofen pump.
Opening blood flow is not recommended because it is ineffective and may not be safe for people
with MS. If not treated, this may lead to bad prognosis. MS itself is rarely fatal, but complications
may arise from severe MS, such as chest or bladder infections, or swallowing difficulties. The
average life expectancy for people with MS is around 5 to 10 years lower than average, and this
gap appears to be getting smaller all the time.
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CHAPTER VI
COMPREHENSIVE ASSESSMENT
Guidelines Normal values Day 1 Day 2 Day 3
October 5, 2023 October 6, 2023 October 7, 2023

I.Mental Status
a. State of mental
consciousness Awake , coherent, The patient was awake, The patient was awake, The patient was awake,
and responsive coerent, and was able coerent, and was able coerent, and was able
response response response
b. Orientation
Oriented to time, The patient is aware of The patient is aware of The patient is aware of
place, and person time, place, and person time, place, and person time, place, and person
c. Intellectual
capacity Can understand Simple concepts can be Simple concepts can be Simple concepts can be
simple concepts understood by the understood by the understood by the
patient patient patient
d. Vocabulary
level Can speak The patient is fluent in The patient is fluent in The patient is fluent in
English, bisaya both English, bisaya both English, bisaya both English, bisaya
and tagalog and Tagalog. and Tagalog. and Tagalog.
languages
e. Attention span
Listens and The patient listens The patient listens The patient listens
responds with full carefully and responds carefully and responds carefully and responds
thoughts fully. fully. fully.
30
f. Ability to
understand Understands The patient The patient The patient
instructions given understands the nurse's understands the nurse's understands the nurse's
by the nurse instructions instructions instructions
II.Status of Special
Senses
a) Auditory Able to hear The patient's ability to The patient's ability to The patient's ability to
perception normally and hear normal and hear normal and hear normal and
whispered voices whispered voices whispered voices whispered voices
b) Visual Can see near The patient can see The patient can see The patient can see
perception objects without things in close things in close things in close
the need of proximity without proximity without proximity without
glasses glasses. glasses. glasses.
c) Speech Speaks clearly The patient speaks The patient speaks The patient speaks
perception and audible clearly and audibly. clearly and audibly. clearly and audibly.
d) Tactile Identifies area of Identifies light touch Identifies light touch Identifies light touch
perception light touch, areas and distinguishes areas and distinguishes areas and distinguishes
differentiate between strong and between strong and between strong and
between sharp and dull feelings dull feelings dull feelings
dull sensations
e) Olfactory Able to The patient's ability to The patient's ability to The patient's ability to
perception distinguish recognize specific recognize specific recognize specific
different kinds of kinds of odors kinds of odors kinds of odors
odor
III.Motor ability
31
a. Current
mobility Able to sit and Incapable of sitting and Incapable of sitting and Incapable of sitting and
walk without walking without walking without walking without
assistance assistance assistance assistance
b. Posture
Relaxed with The patient is relaxed, The patient is relaxed, The patient is relaxed,
shoulders back with shoulders back with shoulders back with shoulders back
and both feet and both feet are and both feet are and both feet are
stable unstable due to unstable due to unstable due to
numbness of her lower numbness of her lower numbness of her lower
extremities. extremities. extremities.
c. Range of
motion Can flex and The patient is unable to The patient is unable to The patient is unable to
extend extremities flex and extend her flex and extend her flex and extend her
extremities. extremities. extremities.
d. Muscle and
nervous status Firm, developed, The patient is The patient is The patient is
and coordinated undependable, mature, undependable, mature, undependable, mature,
and well-organized and well-organized and well-organized
e. Loss of
extremities None The patient felt The patient felt The patient felt
numbness of her lower numbness of her lower numbness of her lower
extremities extremities extremities
IV. Body Temperature
a) Ranges 36.5°C - 37.5°C 36.5 °C 36.8 °C 37.0 °C

(warm to touch)
V. Respiratory Status
32
• 12 - 20 cpm
a) Character • Regular and 20 cpm 21 cpm 21 cpm
spontaneous
b) Use of None None None None

respiratory
c) Interference None None None None

with respiration
d) Abnormal None None None None

respiratory opening
e) Intravenous None None None None

Fluids
VI. Circulatory
Status
a. Characteristic Regular, strong, Regular, strong, and Regular, strong, and Regular, strong, and
of and palpable palpable palpable
arterial pulse palpable
b. Apical-radial 60 - 100 bpm 77 bpm 86 bpm 98 bpm

pulse
c. Blood Pressure 90/60 mmHg - 100/60 mmHg 110/90 mmHg 110/80 mmHg
120/80 mmHg
d. Mean arterial (DP x 2 + SP/3

pressure =70 -
100mmHg
33
e. Intravenous None Heplock Heplock Heplock
Fluids
VII. Nutritional
Status
a. Condition of • Teeth
buccal cavity straight with no Teeth in perfect Teeth in perfect Teeth in perfect
cavities alignment and free of alignment and free of alignment and free of
• Lips are cavities; lips smooth, cavities; lips smooth, cavities; lips smooth,
pink, smooth, rosy, and hydrated. rosy, and hydrated. rosy, and hydrated.
and moist. Pink, sturdy, and Pink, sturdy, and Pink, sturdy, and
• Gums are smooth gums follow the smooth gums follow the smooth gums follow the
smooth, firm, bright red tongues and bright red tongues and bright red tongues and
and pink papillae papillae papillae
b. Digestion of DAT DAT DAT

food Masticates food
well and able to
digest food
without
difficulty
c. Weight Within normal 21.9 21.9 21.9

BMI range
VII. Elimination
Status
a. Bowel • Bowel • Bowel sounds - • Bowel sounds - • Bowel sounds -

sounds - soft soft soft soft
34
• No stool • No stool • No stool • No stool
b. Bladder • No • Reports urinary Urine is clear and Urine is clear and

presence of frequency yellow with no foul yellow with no foul
urinary • Urine is clear and odor odor
frequency yellow with no foul
• Urine is odor
clear and yellow
with no foul
odor
c. Abnormalities None None None None
IX. Status of Skin

and Appendages
a. Skin No Upon assessment No Upon assessment No Upon assessment No

inconsistency, bruises, wounds, or bruises, wounds, or bruises, wounds, or
wounds, or inconsistent color. Light inconsistent color. Light inconsistent color. Light
bruising to dark brown, smooth to dark brown, smooth to dark brown, smooth
texture texture texture
b. Hair Lustrous, shiny, Lustrous, shiny, and Lustrous, shiny, and Lustrous, shiny, and
and well- well-distributed well-distributed well-distributed
distributed
c. Nails Well-trimmed, The patient's nails are The patient's nails are The patient's nails are
clean, firm, and neatly clipped, hard, neatly clipped, hard, neatly clipped, hard,
pink nail beds and pink. and pink. and pink.
X. States of
Physical rest and
comfort
35
a. Sleep/rest Able to sleep 3- Not able to sleep 3-6 Not able to sleep 3-6 Not able to sleep 3-6
pattern 6 hours a day hours a day hours a day hours a day
b. Presence of No presence of With the presence of With the presence of With the presence of
pain/discomfort pain and pain and discomfort pain and discomfort pain and discomfort
discomfort (8/10) (7/10) (9/10)
c. Use of No usage of • Wheelchair • Wheelchair • Wheelchair

supportive aids supporting aids • Compression • Compression • Compression
stocking stocking stocking
• Compression • Compression • Compression
therapy leg brace therapy leg brace therapy leg brace
• Urine Foley • Urine Foley • Urine Foley
catheter catheter catheter
•
XI. Emotional
Status
a. Emotional Open, Positive coping Positive coping Positive coping

reaction expressive, and strategies are strategies are strategies are
verbalizes articulated, open, and articulated, open, and articulated, open, and
positive coping expressive. expressive. expressive.
mechanisms
b. Body image With high self - With low self -esteem With low self -esteem With low self -esteem
esteem
c. Ability to Interact with Often interact with Often interact with Often interact with
relate to others other people other people other people other people
36
XII. Nursing Diagnosis
1. Acute Pain related to altered sensory perception and nerve damage associated with multiple sclerosis as evidenced by a pain
scale of 8/10 and numbness in her lower extremities
2. Impaired Physical Mobility related to sensory deficits and muscle weakness secondary to multiple sclerosis
3. Risk for Impaired Skin Integrity related to immobility and altered sensation
4. Impaired Urinary Elimination related to bladder irritation as evidenced by urgency and frequency
5. Disturbed Sleep Pattern related to severe pain interfering with the ability to achieve restful sleep
ANALYSIS
The patient was conscious, communicative, and had good coping mechanisms in place, but has a low self-esteem and frequently
interacts with others. The patient cannot sit or walk without assistance and unable to flex and extend his extremities due to the numbness
in her lower extremities. As a result of her health, the patient uses supportive devices such as wheelchair, compression stocking , and
compression therapy leg brace. The patient experienced intense and severe pain and discomfort during her hospitalization. Her body
pain and discomfort was recorded as follows; a scale of 8/10 on the first day, a scale of 7/10 on the second day and a scale of 9/10 on
the third day. Temperature was recorded as follows; 36.5 on the first day, 36.8 on the second day, and 37.0 on the third day. Vital signs
were within normal bounds. Teeth are well positioned and cavity-free; lips moisturized, pink, and smooth. Bright red tongues and
papillae are followed by smooth, firm, and pink gums. Status of Skin and Appendages are normal. No bruises, wounds, or inconsistent
color. Light to dark brown, smooth texture. Patient urine is clear and yellow without any unpleasant odors for three days in a row, but
no stool.The patient was able to sleep three to six hours in a day..
37
CHAPTER VII
COURSE IN THE WARD, TREATMENT, AND INTERVENTION
I. Medical Management
1. Doctor’s Progress Notes
Progress notes Physician’s order Rationale
Date and Time: DAT To let the patient recover quickly through consuming enough
food.
October 23, 2023
@ 8AM
Prosure 5 Scoops Per ServinG For additional nutrition the patient needs.
BP: 120/80mmHg With Heplock To prevent the formation of blood clots near the surface of the
skin.
T: 36.4 °C
RR: 20 cpm S’p Posterior Decompression To relieve the pressure and reduce local inflammatory
reactions around the nerve root.
SpO2: 96%
WT: 54 kgs. Instrument T3-T4 T7 Evaluate thyroid nodules and detect conditions like
hyperthyroidism and hypothyroidism.
38
S’p Unit Prbc Use to treat anemia
Incentive Spirometry Helps prevent lung infections by expanding your lungs.
Cardiothoracic Lumbar Brace (Refer Used to limit movement in the spine from the thoracic area to
Whether To Ortho Rehab) the sacrum.
VS q4 To obtain baseline data and monitor abnormalities.
Daily Pt To improve and restore movement, strength, range of motion,

and decrease pain
Clindamycin 300MG Used to treat serious infections caused by susceptible bacteria.
Bethanechol 1 Tab
Used to treat urinary retention (trouble urinating) that may be
caused by surgery, delivering a baby, or other condition.
Cephalexin,1 tab B.I.D Used to treat infections caused by bacteria, including upper
respiratory infections, ear infections, skin infections, urinary
tract infections and bone infections.
39
Caltrate Plus
Used to prevent or treat low blood calcium levels. It is also used
to help growth and good health, prevent or treat soft, brittle
bones (osteoporosis), and treat or prevent low calcium levels.
Tramadol B.I.D X7 Days

Used to treat moderate to severe pain
Multivitamins 1 Tab
Used to treat or prevent vitamin deficiency due to poor diet or
certain illnesses.
Vitamin Complex O.D

Used to treat or prevent vitamin deficiency due to poor diet,
certain illnesses, alcoholism, or during pregnancy.
Prednisone (After Breakfast)

used as an anti-inflammatory or an immunosuppressant
medication.
Vitamin C -1 tab O.D
To treat and prevent vitamin C deficiency and its symptoms,
such as scurvy, bleeding gums, and faulty bones and tooth
development.
Mometasone Cream
Used to treat the symptoms of certain skin conditions, such as
pain, redness, warmth, swelling, or itching.
Memantine for Daily

Used to treat moderate to severe confusion ( dementia)
Enoxaparin
Used to prevent and treat harmful blood clots
40
2. Laboratory/Diagnostic Examinations
Procedure Purpose Normal Results Nursing Management

Range/Result
X-Ray Thoracic To identify a range Normal thoracic X-ray reveals ● Remove all metallic objects.
Apl of issues with the spine with no normal bony ● Ensure the patient is not pregnant
bones located in the signs of injuries structures and no or suspected to be pregnant.
middle of the back. and abnormalities ● Provide appropriate clothing.
It aids in spotting abnormalities. detected. ● Instruct the patient to cooperate
abnormalities, during the procedurE.
injuries, and ● Provide comfort
diseases of the
bone.
● Instruct the patient to avoid going directly

Urinalysis To detect and Color: Yellow Color: Yellow into a clean, dry container.
manage a wide (light/pale)
range of disorders, Clarity/Turbidity:
such as urinary tract Clarity/turbidity: Clear
infections, kidney clear or cloudy
pH: 5.5
disease, and
diabetes. pH: 4.5-8
Specific gravity: 1.025
Specific gravity:
1.005-1.025
41
● Advise patients to avoid alcoholic drinks
CBG To measure and 4 to 6 mmol/L or 6 mmol/L or 108 with anti-hyperglycemic medication.
assess the glucose 72 to 108 mg/dL mg/dL ● Emphasize the benefits of eating right and
levels on time. Explain the need to eat carbohydrate-rich
food before exercising.
● Provide patient and family education on

MRI (Magnetic A non-invasive Imaging study Imaging study multiple sclerosis, including symptoms,
Resonance imaging technique did not reveal any reveals presence of medications, and self-management strategies.
Imaging) that uses magnetic abnormalities. demyelinating
fields and radio lesions. It appears as ● Collaborate with the healthcare team to
waves to produce bright spots on the
address symptom management, mobility issues,
detailed images of MRI images.
psychosocial support, and overall well-being for
internal structures, individuals with MS.
aiding in the
diagnosis and
evaluation of
various medical
conditions.
42
3. Pharmacological Management
a. Prednisone
DRUG NAME CLASSIFICATION / INDICATION CONTRAINDICAT SIDE ADVERSE NURSING
IONS EFFECTS
MECHANISM OF ACTION EFFECTS RESPONSIBILITY
Brand name: CLASSIFICATION: • Arthritis Hypersensitivity • Agitation • Nausea • Check the

Prednisone is in a class of • Blood • blurred • Vomitin physician’s
N/A medications disorders vision g order.
Generic:
called corticosteroids. • Breathing • decrease • Loss • Check for allergic
problems in the of appeti reactions.
Prednisone MECHANISM OF • severe amount of te • Give one dose
ACTION: allergies urine • heartburn daily.
Dosage: Prednisone decreases • skin diseases • dizziness • trouble • Administer
inflammation via suppression • cancer sleeping drug with food
N/A of the migration • eye problems • increased or milk.
Route:
of polymorphonuclear • and sweating • Monitor
leukocytes and reversing immune system • acne may patient’s
Oral increased capillary disorders. occur bp, sleep
permeability. It also patterns, and
Frequency: suppresses the immune potassium
system by reducing the level
N/A activity and the volume of the • Increase dose if
immune system. Patient is subject
REFERENCE: to stress.
Prednisone oral: Uses, side
effects, interactions, pictures,
warnings & dosing -
WebMD. (n.d.).
https://www.webmd.com/
drugs/2/drug6007- 9383/predn
isone- oral/prednisone-
oral/details
43
b. Enoxaparin
IONS EFFECTS EFFECTS
MECHANISM OF RESPONSIBILITY
ACTION
Brand name: Pharmacological Class: Enoxaparin is Hypersensitivity to • dizziness CNS: • Assess for signs
Antithrombotics indicated for the specific agents or; • headache Dizziness, of bleeding and
Lovenox prevention of cross-sensitivity may headache, hemorrhage
Therapeutic Class:
Generic: ischemic occur; Some products insomnia. • Assess patient for
Anticoagulants complications in contain sulfites or evidence of
Enoxaparin unstable angina and benzyl alcohol and CV: edema
MECHANISM OF additional or
ACTION: in non-Q-wave should be avoided in GI: increased
Dosage:
myocardial patients with known constipation, thrombosis.
Asyringes (prefill Enoxaparin binds to infarction. Also hypersensitivity or nausea, Symptoms
ed): 30m g / 0 . 3 antithrombin III, a serine indicated in the intolerance; Active vomiting depend on area of
ml, 40 mg/0.4m protease inhibitor, forming prophylaxis of DVT major bleeding; involvement
l a complex that irreversibly in abdominal History of heparin- GU: urinary • Monitor for
inactivates factor Xa, which surgery, hip induced retention hypersensitivity
is frequently used to replacement, knee thrombocytopenia. reactions, (chills,
Route: monitor anticoagulation in replacement, or fever)
Subcutaneous the clinical setting. medical patients with • Monitor patients
severely restricted with epidural
Frequency: REFERENCES:
mobility during acute catheters
Enoxaparin: Uses, illness. frequently for
Once a day
signs and
interactions, mechanism of symptoms of
neurologic
action | DrugBank Online. impairment.
(n.d.). DrugBank.
https://go.drugbank.com/dr
ugs/DB01225
44
c. Multivitamins
ACTION
Brand name: Contains fat-soluble This medication is an This is ● Nausea ● Hives ● Encourage
vitamins (A, D, and E) and essential nutrient, contraindicated to patient to comply with
Hexavitamin most water-soluble prescribed for patients with ● Difficult recommendations of
vitamins (B-complex patients with vitamin hypersensitivity to the y health care
Generic: breathin
vitamins B1, B2, B3, B5, deficiency. drug. professionals.
Multivitamins B6, B12, vitamin C, biotin, Normally provided in g
and folic acid). These combination with ● Explain that
Dosage: ● Swelling the best source of
vitamins are a diverse group dietary minerals. of face,
of compounds necessary for vitamins is a well-
1 tab 500mg lips,
normal growth and balanced diet with foods
tongue, from the 4 basic food
Route: development. Many act as or throat. groups.
coenzymes or catalysts in
Oral
numerous metabolic ● Instruct the
Frequency: processes. Liquid products patient and watcher to
do not contain folic acid. avoid take the
Once a day
REFERENCES: multivitamins with milk
or any other dairy
D, D. J. P. (2023, October products.
4). Multivitamins: benefits,
uses, side effects, dosages, ● Instruct the
warnings, interactions. watcher to watch out for
RxList. unusual signs like
https://www.rxlist.com/mul swelling and difficulty
tivitamins/generic- breathing
drug.htm
45
d. Vitamin B complex
MECHANISM OF ION EFFECTS EFFECTS RESPONSIBILITIES
ACTION
Brand name: Vitamin B complex is a This drug is This is ● Nausea ● Na ● Assess patient
Care of B-complex group of eight vitamins that indicated for contraindicated to the ● Fatigue usea and for signs of vitamin
vitamin are essential for various preventing patient with known ● Diarrhea vomiting deficiency before and
functions and health infections and hypersensitivity or ● abdominal ● Hea periodically during
Generic: conditions. The active supporting cell allergy to any of the pain dache therapy.
Vitamin B complex forms of thiamine, health, red blood cell components of ● Fati ● Assess
riboflavin, niacin, and growth, energy vitamin B gue or nutritional status
Dosage: pantothenic acid are levels, eyesight, supplements or foods. weakness through 24-hr diet recall
1 tab 500mg essential co-enzymes in brain function, ● Ski and frequency of
mitochondrial aerobic digestion, appetite, n flushing or consumption of vitamin-
Route: respiration and cellular and nerve function. pain rich foods.
Oral energy production via their It is also prophylaxis ● Tin ● Notify
direct roles in the citric acid of vitamin B gling physician of any
Frequency: cycle, the electron transport complex deficiency. sensation in intercurrent disease or
Once a day chain and the resultant hands and infection that may
formation of adenosine feet require increased
triphosphate (ATP), the dosage.
cell’s energy currency . ● Obtain a
REFERENCES: complete diet and drug
Vitamin B complex | history.
DrugBank Online. (n.d.). ● Instruct the
DrugBank. watcher for any unusual
https://go.drugbank.com/ca sign of allergic reaction
tegories/DBCAT000236 like swelling and
difficulty breathing
46
e. Bethanechol
MECHANISM OF ION EFFECTS RESPONSIBILITIES
ACTION EFFECTS
Brand name: CLASSIFICATION: Patients with a • Hypersensiti • nausea, ● fast heart • Nursing
Bethanechol sensory and motor vity • fatigue beat considerations when
Chloride Bethanechol is a paralyzed • ● severe caring for a client taking
Hyperthyroi • abdominal
parasympathomimetic bladder as well as abdominal bethanechol include a
dism pain
Generic: drug. spinal shock subjects pain. focused assessment of
• Peptic • dizziness
Bethanechol MECHANISM OF who have recovered ulcer ● fainting urinary symptoms, and
ACTION: to the degree • Latent monitoring for side
Dosage: 5 mg of voluntary control bronchial asthma effects and therapeutic
Bethanechol exerts its of the urethra may • Active effects.
Route: Subcutaneous effects via directly find use for bronchial asthma • Client teaching
Frequency: stimulating the muscarinic bethanechol. • Bradycardia is focused on self
4 times a receptors (M1, M2, M3, administration and
• Orthostatic
Day M4, M5) of the Treatment learning to recognize
hypotension
parasympathetic nervous of postoperative urin • Vasomot and
system, further ary retention, or instability manage side effects.
increasing the tone of the postpartum urinary • Coronary • Ensuring that
detrusor urinae muscle of retention, and artery disease the right medication is
the bladder, giving a overflow administered at the right
• Epilepsy/
contraction adequately incontinence caused seizures time through the right
effective to initiate route to the right patient
by neurogenic atony • Parkinsonis
micturition and void the properly drawn up in the
of the bladder. m
bladder.[5][3][6] The M3 correct dose, and
receptors are where the • Arrhythmias
administered at the right
agent acts in the bladder • Angle- time through the right
and are also present in closure glaucoma route to the right patient.
smooth muscles and • Intestinal
exocrine glands. resection or
anastomosis
REFERENCE: • Urinary
obstruction
Padda, I. S. (2023, June 3).
• Severe
Bethanechol. StatPearls -
miosis
NCBI Bookshelf.
https://www.ncbi.nlm.nih.g
ov/books/NBK560587/
47
f. Tramadol
MECHANISM OF ION EFFECTS EFFECTS RESPONSIBILITIES
ACTION
Brand name: N/A CLASSIFICATION: • Moderate to • Hypersensitivity • Nausea CNS: seizur
• Reassess patient’s
Tramadol is in a class of moderately to Tramadol and • Dry es, dizziness
Generic name: medications called opiate severe pain. to other opioid mouth , headache, s level of pain at least
Tramadol (narcotic) analgesics. analgesics • headache omnolence,
MECHANISM OF anxiety, 30 minutes after
• Known or
Dosage: N/A ACTION: CNS administration.
suspected
Binds to mu-opioid stimulation,
gastrointestinal • Monitor bowel and
Route: Oral receptors. Inhibits reuptake confusion,
of serotonin and obstruction, coordination
including bladder function.
Frequency: Two times norepinephrine in the disturbance,
a day CNS. paralytic ileus. euphoria, • Monitor patient at
REFERENCE: malaise,
risks for seizures.
Tramadol. (n.d.). McGraw nervousness,
Hill Medical. sleep • Help patient
https://fadavispt.mhmedica disorder,
l.com/content.aspx?bookid weakness. explore other
=1873§ionid=139028867 EENT: visu nonpharmacologic
al
disturbances methods to reduce
CV: vasodil chronic pain, such
ation
GI: constipa as relaxation
tion, nausea,
techniques,
abdominal
pain, exercise,
anorexia,
diarrhea, dry counseling, and so
mouth, forth.
dyspepsia,
flatulence, • Guard against falls
vomiting and trauma such as
GU: menop
ausal hip fractures or
symptoms,
head injury.
urinary
Implement fall-
48
retention/fre
prevention
quency
Derm: pruri strategies,
tus,
sweating especially if patient
Neuro: hype exhibits sedation,
rtonia
Misc: physi dizziness, or blurred
cal vision.
dependence,
psychologic • Advise patient that
al
centrally acting
dependence,
tolerance analgesics are
usually more
effective if given
before pain
becomes severe;
emphasize that
adequate pain
control will allow
better participation
in physical therapy.
• Educate patient
about the dangers of
overdose;
encourage patient to
adhere to proper
dosing schedule.
49
• Advise patient to
avoid alcohol and
other CNS
depressants because
of the increased risk
of sedation and
decreased CNS
function.
• Advise patient to
increase fluid
intake.
50
g. Mometasone furoate
MECHANISM OF ACTION RESPONSIBILITY
Brand name: CLASSIFICATION: Mometasone furoate Mometasone furoate • Acne • Burning • Apply a thin film
Elica cream, USP, 0.1% is cream, USP, 0.1% is • Burning • Pruritus of ELOCON
Mometasone is in a class of a corticosteroid contraindicated in • skin Alcohol Free
Generic: medications indicated for the those patients with a atrophy Cream or
Mometasone called corticosteroids. relief of the history of Ointment or a few
furoate inflammatory and hypersensitivity to
MECHANISM OF drops of ELOCON
Dosage: ACTION: pruritic any of the components Lotion to the
manifestations of in the preparation. affected skin or
1 mg/ml Corticosteroids diffuse across corticosteroid- scalp once daily.
cell membranes into the cytosol responsive Massage gently
Route: Skin of cells where they bind to dermatoses in until it disappears.
glucocorticoid receptors to patients ≥ 2 years of • It is important to
Frequency: OD
produce their activity. age. use ELOCON
Mometasone furoate has a
particularly high receptor exactly as your
affinity compare to other doctor or
corticosteroids, 22 times higher pharmacist has
than that of dexamethasone2. told you. If you use
Mometasone furoate binding to it less often than
a glucocorticoid receptor you should, it may
causes conformational changes not work as well
in the receptor, separation from and your skin
chaperones, and the receptor problem may not
moves to the nucleus. Once at improve. Using it
the nucleus, receptors dimerize more often than
and bind to a DNA sequence
you should may
known as the glucocorticoid
not improve your
response element which either
increases expression of anti- skin problem any
inflammatory molecules or faster and may
inhibits expression of pro- cause or increase
inflammatory molecules. side effects
Mometasone furoate also
51
reduces inflammation by
blocking transcription factors
such as activator-protein-1 and
nuclear factor kappa B.
REFERENCE:
Mometasone furoate: Uses,
Interactions, Mechanism of
Action | DrugBank Online.
(n.d.). DrugBank.
https://go.drugbank.com/drugs
/DB14512
52
h. Clindamycin
ACTION
Brand Name: CLASSIFICATION: Treatment of serious • Contraindi • Fatigue CV: • Assess

Lincosamide infections caused by cated with allergy to • abdominal hypotension, allergy to
Dalacin C
MECHANISM OF susceptible strains of clindamycin or pain cardiac clindamycin, history
ACTION: Inhibits protein anaerobes lincomycin • joint pain arrest of asthma or other
Generic Name:
synthesis in streptococci, • Use caution allergies; hepatic or
Clindamycin GI: renal dysfunction,
susceptiblebacteria at level staphylococci, with history of
Dosage: 300 mg of 50S ribosome, thereby pneumococci regional enteritis or pseudomem lactation, history of
inhibiting peptide bond ulcerative colitis; branous regional enteritis or
formation and causing cell history of antibiotic colitis ulcerative colitis,
death. history of antibiotic
Route: ORAL associated colitis.
Hema: associated colitis.
REFERENCE: neutropenia, • Culture
Kizior, R. J., & Hodgson, leucopenia, infection before
Frequency: BID
K. J. (2021). Saunders agranulocyto therapy.
Nursing Drug Handbook sis, • Do not use for
2021. Elsevier. eosinophilia minor bacterial
or viral
Hypersensit infections.
ivity: rashes, • Monitor LFTs and
urticaria to renal function
anaphylactoi tests, and blood
d reaction counts with
prolonged
Local: pain therapy.
followinginj
ection,
thrombophle
bitis after IV
use
53
i. Cephalexin
ACTION
Brand Name: ClLASSIFICATION: Cephalexin is Cephalexin is • Nausea Reproducti ● Assess for

Antibiotic indicated for the contraindicated in • Fatigue ve: infection vita
Keflex
MECHANISM OF treatment of certain patients with known • abdominal Isigns,WBC)
Vaginal
ACTION: Cephalexin is a infections caused by hypersensitivity to pain
Itching or ● Obtain
Generic Name: first generation susceptible bacteria. cephalexin or other Discharge history to determine
Cephalexin cephalosporin antibiotic. These infections members of the previous use of and
Cephalosporins contain a include respiratory cephalosporin class of Vascular:D reactions to
Dosage: 500 mg beta lactam and AVAO
tract infections, otitis antibacterial drugs penicillins
Route: Oral (PO) hydrothiazide. Unlike media, skin and skin
penicillins, cephalosporins Ecchymosis ● Obtain
structure infections,
are more resistant to the bone infections, and pale specimen for culture
Frequency: BID action of beta lactamase. skin(pallor), and sensitivity before
genitourinary tract
Cephalexin inhibits cold hands initiating therapy
infections
bacterial cell wall synthesis, and feet;
leading to breakdown and ● Observe
eventual cell death. CNS: patient signs and
symptoms of
REFERENCE: Seizures anaphylaxis
Kizior, R. J., & Hodgson,
Paresthesia ● Dis-
K. J. (2021). Saunders
continue and notify
Nursing Drug Handbook Respiratory physician if these
2021. Elsevier. : problem occur.
Feeling
light-headed
or short of
breath;
54
j. Calcium Carbonate
DRUG NAME CLASSIFICATION / INDICATION CONTRAINDIC SIDE ADVERSE NURSING
ATIONS EFFECTS EFFECTS
MECHANISM OF ACTION RESPONSIBILITY
BRAND NAME: CLASSIFICATION: It is used to Contraindicated to • Dry mouth Constipation • Administer

prevent and treat patient who is or stomach prescribed
Caltrate Plus Calcium supplement low blood calcium allergic to vitamin upset medication as
GENERIC: MECHANISM OF ACTION: levels and ensure D products and ordered.
they are getting renal insufficiency • Assess patient for
Calcium Carbonate Calcium carbonate is a basic enough calcium any history of
inorganic salt that acts by allergy to Calcium
DOSAGE: neutralizing hydrochloric acid in supplements.
1 tab gastric secretions. It also inhibits • Monitor patient
the action of pepsin by increasing blood calcium
ROUTE: the pH and via adsorption. levels.
Cytoprotective effects may occur
Oral
through increases in bicarbonate
FREQUENCY: ion (HCO3-) and prostaglandins.
Neutralization of hydrochloric
OD acid results in the formation of
calcium chloride, carbon dioxide
and water.
REFERENCE:
Wishart DS, Knox C, Guo AC,

Shrivastava S, Hassanali M,
Stothard P, Chang Z, Woolsey J.
Drugbank: a comprehensive
resource for in silico drug
discovery and exploration.
Nucleic Acids Res.
https://go.drugbank.com/drugs/D
B06724
55
k. Ascorbic Acid

ACTION
BRAND NAME: CLASS: This drug is given to Contraindicated in • stomach • Stom • Administer
support the immune blood disorders like cramps ach cramps prescribed medication
Vital C Antioxidants system and enhance thalassemia, G6PD • decreased • Naus as ordered.
GENERIC: MECHANISM OF iron absorption. deficiency, sickle cell urination ea • Assess the
ACTION: disease, and • nausea • Head patient for any history
Ascorbic Acid hemochromatosis. aches of allergy to ascorbic
Ascorbic acid functions as • Flus acid.
DOSAGE: a cofactor, enzyme hing • Give the drug
1 tab complement, co-substrate, Heartburn with food to help
and a powerful anti-oxidant decrease the potential
ROUTE: in various reactions and gastrointestinal side
metabolic processes. It also effects caused by its
Oral
stabilizes vitamin E and high acidity.
FREQUENCY: folic acid and enhances • Observe and
iron absorption. document any changes
OD that may occur.
REFERENCES:
Abdullah, M., Jamil, R. T.,

& Attia, F. N. (2022,
January 25). Vitamin C
(Ascorbic Acid). Nih.gov;
Stat Pearls Publishing.
https://www.ncbi.nlm.nih.g
ov/books/NBK499877/#:~:
text=Ascorbic%20acid%20
functions%20as%20a,acid
%20and%20enhances%20i
ron%20absorption
56
l. Memantine
ACTION
BRAND NAME: CLASSIFICATION: Memantine is ● ever had an • ●

Dizziness Bloating or • Swallow the
Namenda Memantine is in a class of used to treat allergic reaction to • agitation swelling of the extended-release
medications called NMDA moderate to severe memantine or any face, arms, capsules
GENERIC: receptor antagonists.. confusion other medicine. hands, lower whole. Do not
Memantine (dementia) related to legs, or feet. break, crush, or
MECHANISM OF Alzheimer's disease. ● epilepsy or have chew them
DOSAGE: 5 mg ACTION: ever had a seizure ● ingling of the
It does not cure • Assess blood
ROUTE: Oral The principal mechanism of Alzheimer's disease, or fit. hands or feet..
pressure (BP) and
action of memantine is but it may improve ● ever had a heart ● unusual compare to
FREQUENCY: 1 believed to be the blockade of memory, awareness, attack. weight gain or normal values
tab once a day current flow through channels and the ability to loss. • Monitor signs of
of N-methyl-d-aspartate perform daily ● heart failure. anemia, including
(NMDA) receptors--a functions. ● tingling of the unusual fatigue,
glutamate receptor subfamily ● high blood hands or feet. shortness of
broadly involved in brain pressure.
breath with
function. ● slow or fast
● kidney or liver exertion, pallor,
heartbeat.
REFERENCE: problems. and bruising.
Notify physician
Johnson, J. W., & if these signs
Kotermanski, S. E. (2006b). occur.
Mechanism of action of
• Periodically
memantine. Current Opinion
in Pharmacology, 6(1), 61– assess body
67. weight and other
https://doi.org/10.1016/j.coph anthropometric
.2005.09.007 measures (body
mass index, body
composition).
Report a
substantial
weight gain or
57
increased body
fat.
• Guard against
falls and trauma
(hip fractures,
head injury, and
so forth) caused
by drowsiness,
dizziness, or
other drugs;
implement fall
prevention
strategies
58
II. Nursing Management
1. Nursing Care Plan
a. Acute Pain
PROBLEM SCIENTIFIC GOALS/ NURSING RATIONALE EVALUATION

BASIS
OBJECTIVES INTERVENTIONS
CRITERIA
October 7, 2023 Acute Pain related to After 8 hours of span of 1. Conducted •a Accurate and consistent pain October 7, 2023
altered sensory care, the patient will be thorough pain assessment provides baseline for
7:00 AM perception and able to: assessment using a evaluating the effectiveness of care 3:00 PM
nerve damage numeric pain scale and tailoring care to the patient’s
associated with A. Alleviate acute pain and asked the patient needs.
Subjective: “GOAL
multiple sclerosis as to a manageable to describe the pain
• Patient PARTIALLY MET”
evidenced by pain level for the patient characteristics.
verbalizes pain
scale of 8/10 and
episodes After 8 hours of span
numbness in her B. Enhance the
characterized by patient’s ability to 2. Administered • Pharmacological interventions aim of care, the patient was
lower extremities
“naay murag cope with acute pain prescribed analgesics to reduce pain intensity and able to:
sensations as ordered by the improve patient comfort during
BASIS:
na burning
Acute pain has a C. Minimize the healthcare provider. acute pain. A. Alleviated acute
tapos kanang impact of acute pain pain to a
scientific basis rooted
lain ang pain
in the detection and on the patient’s manageable level
murag shooting
transmission of overall well-being 3. •
Assisted the patient Proper positioning helps relieve for the patient
pain ko nafeel in finding pressure on affected areas,
noxious stimuli D. Improve the
ma’ám”. comfortable potentially reducing nerve-related B. Enhanced the
through nociception, patient’s overall positions that may pain. patient’s ability to
• “Kanang ga involving intricate quality of life alleviate pressure on cope with acute
binhod akoa neurobiological
processes from affected nerves. pain
baba ma’am na
wala ko kasabot peripheral nerves to
the central nervous • Cold or heat therapy can help C. Minimized the
modulate pain perception and impact of acute
system, influencing pain on the
59
as verbalized by the perception and 4. Applied cold or hot provide relief from acute patient’s overall
the patient. interpretation of pain. packs to the affected discomfort. well-being
areas as appropriate.
REFERENCES: Distraction techniques can help D. Patient’s overall
Objectives: Bsn, G. W., RN. shift the patient's attention away health is still in
• Pain scale of (2023, October 12). 5. Introduced from pain, promoting relaxation and monitoring.
8/10 Acute Pain Nursing distraction reducing the perception of
• Signs of Care plan and techniques such as discomfort.
distress due to Management. guided imagery or
fatigue Nurseslabs. listening to music to
• Weakness and https://nurseslabs.co redirect the patient’s
fatigue are m/acute-pain focus during acute
observed pain. • Strengthening exercises can
contribute to overall
musculoskeletal health, potentially
6. Collaborated with a reducing the impact of nerve-related
physical therapy pain.
team to develop
specific exercises
aimed at improving
muscle strength and
flexibility.
60
b. Impaired Physical Mobility

BASIS
CRITERIA
October 7, 2023 Impaired Physical After 8 hours of span of 1. Assessed vital It serves as the baseline data. October 7, 2023
Mobility related to care, the patient will be signs.
7:00 AM sensory deficits and able to: 3:00 PM
muscle weakness
To clarify intervention needs and
secondary to A. Maintain or
Subjective: 2. Determined the priorities. “GOAL
multiple sclerosis increase strength and client’s level of comfort. PARTIALLY MET”
Di kaayo ko function of affected or
katarung ug lihok BASIS: compensatory body part. After 8 hours of span
To determine the presence of
kay binhod pa B. Demonstrate 3. Assessed characteristics of client’s unique of care, the patient was
verbalized by the Limitation in impairment and to guide choice of able to:
techniques or behaviors client’s developmental
patient. independent, intervention.
that enable resumption of level, motor skills, ease
purposeful movement A. Maintained or
activities. and capability of
of the body or of one increased strength and
movement, posture, and
or more extremities C. Participate in function of affected or
gait. Mobility aids like walkers and
their activities of daily compensatory body
Objective: wheelchairs can help decrease
REFERENCES: life and prescribed part.
therapies. 4. Encouraged the fatigue and enhance comfort,
• Decreased use of mobility aids as safety, and independence.
Zhao, J., Chau, J. P. B. Demonstrated
coordination needed.
C., Lo, S. H. S., Choi, techniques or
and balance To help strengthen muscles and
K. C., & Liang, S. behaviors that enable
bones to improve mobility.
• Reliance on (2021). The effects of resumption of
assisted device sitting Tai Chi on 5. Performed activities.
physical and passive range of motion
• Decreased psychosocial health exercises. C. Participated in their
muscle strength outcomes among To increase mobility and promote activities of daily life
individuals with safety. and prescribed
impaired physical therapies.
mobility: A
61
• Observed systematic review and 6. Used assistive Frequent position changes help
muscle meta-analysis. devices such as a walker, reduce burdening pressure points
weakness International Journal cane, or gait belt. for an extended period and reduce
of Nursing Studies, breakdown.
118, 103911. 7. Repositioned
https://doi.org/10.101 the patient at least every
6/j.ijnurstu.2021.1039 two hours and as To help to conserve energy and
11 needed. recharge.
8. Encouraged to
use relaxation techniques To cure or treat a condition, to
during rest periods. reduce symptoms, or to prevent an
illness.
9. Assisted in
administering medication A safe home environment reduces
as ordered such as the risk of falls and injury.
Tramadol 100 mg BID
x7 days.
10. Educated the To help assessed the patient’s

family about functional abilities and formulate an
implementing safety appropriate plan of care.
measures in the home.
11. Referred the

patient to a Physical
Therapist or
Occupational Therapist .
62
c. Risk For Impaired Skin Integrity

BASIS
CRITERIA
October 7, 2023 Risk for impaired After 8 hours of span of 1. Monitored the This will help in identifying the October 7, 2023
skin integrity care, the patient will be patient's skin chances of skin damage which will
7:00 AM related to able to: temperature, color, and develop into a pressure injury. 3:00 PM
immobility and turgor regularly.
Subjective: altered sensation A. Maintain skin intact. “GOAL
This is to reduce or relieve the
”Ang ingon sa 2. Repositioned PARTIALLY MET”
BASIS: B. Demonstrate proper pressure on the area at risk and
doctor kay limited patient’s position
skin care techniques. ensure adequate blood supply to
ra daw akong frequently. After 8 hours of span
Pressure ulcers are a the at-risk area.
lihok” as of care, the patient was
type of injury that
verbalized by the breaks down the skin able to:
These devices helps to relieve
patient. and underlying tissue 3. Used devices pressure.
when an area of skin such as pillows under A. Maintained skin
is placed under heels or lower back. Excess moisture over-hydrates the intact.
Objective: constant pressure for skin, making it weak and more
• Patient uses a certain period B. Demonstratedprop
4. Kept the skin prone to friction, shear, and
assistive causing tissue er skin care
dry and clean. breakdown.
devices ischaemia, cessation techniques.
(wheelchair) of nutrition and Prolonged contact of the skin with
as she can’t oxygen supply to the moisture and soil irritates the skin
walk as per tissues and eventually 5. Bathed the and predisposes it for skin
doctor's order, tissue necrosis. patient daily with pH- breakdown.
patient must Constant pressure
stay in bed. balanced soap, use
resulting in lotions and barrier
‘distortion or creams, and change
deformation damage’ soiled underpads Aids the body to prevent or heal
is probably the most immediately. wounds.
accurate description
of a pressure ulcer
63
REFERENCES: 6. Encouraged Better education helps patients and
Bhattacharya, S., & nutrition and hydration. caregivers understand the care
Mishra, R. K. (2015). setting most appropriate for their
Pressure ulcers: condition
Current 7. Educated the
understanding and patient and caregivers
newer modalities of about the importance of
treatment. Indian regular position changes
journal of plastic
surgery : official
publication of the
Association of Plastic
Surgeons of India.
https://www.ncbi.nlm
.nih.gov/pmc/articles/
PMC4413488/
64
d. Impaired Urinary Elimination

BASIS
CRITERIA
October 7, 2023 Impaired Urinary After 8 hours of span of 1. Assessed voiding Assess the symptoms the patient is October 7, 2023
Elimination related care, the patient will be pattern and experiencing to lead to a diagnosis.
7:00 AM to bladder irritation able to: symptoms. Back/flank pain can signal kidney 3:00 PM
as evidenced by problems. It may be useful to ask
urgency and A. Achieve and the patient to keep a diary of their
Subjective: “GOAL
frequency improve urinary voiding pattern.
“Maglisod kog PARTIALLY MET”
ihi” as stated by elimination pattern free
BASIS: from frequency and A urinalysis and culture can
the patient. 2. Monitored labwork After 8 hours of span
urgency. diagnose or rule out an infection.
and urinalysis. of care, the patient was
Objective: Bladder dysfunction able to:
(urinary urgency, B. Verbalize diet Certain medications have
changes to incorporate to 3. Reviewed anticholinergic effects, which make
frequency, hesitancy,
• Vital signs are improve urinary voiding difficult. These can include A. Achieved and
or incontinence) is medications.
as follows: elimination. antipsychotics, tricyclic improved urinary
common in MS and
antidepressants, and antiparkinson elimination pattern
can significantly
BP -120/80mmHg drugs. free from
impact quality of life.
RR- 20 cpm frequency and
A nursing care plan
PR- 87 bpm urgency.
will address the
Temp: 36.4°C symptoms and Compare intake amount and type
B. Verbalized diet
Oxygen sat: 97% provide ways to (caffeine, water, soda) to the
changes to
• Poor balance manage them. 4. Compared intake amount of urine output as well as
incorporate to
and output. the color (clear, amber,
Management of improve urinary
• Reliance on concentrated) to determine
symptoms may elimination.
assisted hydration levels.
include education on
device
using a catheter,
medications, or Some patients rely on intermittent
• Decreased self-catheterization or permanent
muscle training of the pelvic
suprapubic catheters due to bladder
strength floor muscles. 5. Assessed for issues dysfunction. Ensure they are
with catheterization. performing their catheterizations
65
• patient was on REFERENCES: correctly and not introducing
urinary bacteria due to poor techniques.
catheter Cory Martin (2022),
https://www.verywell
health.com/nursing- Urodynamic testing, cystoscopy,
care-plan-for- and imaging of the
multiple-sclerosis- kidneys/ureters/bladder (KUB) can
5272366 6. Reviewed diagnostic identify structural issues, diseases,
tests. and cancer that may be causing
problems.
66
e. Disturbed Sleep Pattern

BASIS
CRITERIA
October 7, 2023 Disturbed sleep After 8 hours of span of 1. Assessed vital signs. The nurse can also assess for when October 7, 2023
pattern related to care, the patient will be the fatigue started and how long it
7:00 AM severe pain able to: lasted. 3:00 PM
interfering with the
A. Eliminate the pain and 2. Assessed lab values. This will allow the nurse to
Subjective: ability to achieve
determine if any lab values are out “GOAL
“Maglisod kog restful sleep numbness of her lower PARTIALLY MET”
extremities of range as a result of an underlying
tulog kay naay
BASIS: B. Minimize the pain that condition which could be
times na mag After 8 hours of span
the patient has attributing to the patient’s fatigue.
numb ang akong of care, the patient was
Disturbed Sleep experiencing
lower part sakong able to:
body maka mata Pattern is defined as C. Rest and can sleep 3. Provided the patient a
mata ko usahay the presence or risk of tight medicine that can ease It will provide relaxation and make A. Eliminated the
bantug katugon a disruption to normal the pain that her sleepy while reading.
pattern of sleep, pain and numbness
kayko as stated by prescribed by the of her lower
the patient. including amount, physician. extremities
quality, or timing of
B. Minimized the
Objective: sleep. Sleep The pain that the patient is
4. Provided a patient pain that the
• Pain scale of disturbance is often experiencing will decrease.
patient has
8/10 with a book to divert
comorbid with experiencing
• Fatigue her mind at make her
chronic pain sleepy and tired. C. Rested and slept
• weakness is disorders, with tight
observed. emerging evidence
suggesting a stronger To provide the patient with a .
effect of sleep 5.Changed the patient comfortable and relax position.
into a comfortable
disturbance on pain
position.
than vice versa;
however, few studies
have evaluated the
long-term
67
associations between
sleep disturbance and
pain.
Ahernandez. (2023b,
February 28).
Nursing diagnosis
Disturbed sleep
pattern. Nursing
Diagnosis.
https://nandadiagnose
s.com/disturbed-
sleep-pattern/
NANDA
International &
Herdman, T. H.
(2012). NANDA
International Nursing
diagnoses:
Definitions and
classification 2012-
14. Wiley-Blackwell.
68
2. Discharge Plan
In discharge planning, the nurse serves as the connection between in-patient and follow-up
or out-patient care. They assist in ensuring that the patient and their family are aware of what to
do after discharge to avoid risk and improve healing. They're an important aspect of providing
proper patient care. Effective discharge planning can reduce the likelihood of being readmitted to
the hospital, as well as aid in rehabilitation, ensure drugs are ordered and administered correctly,
and properly prepare the patient and the significant other.
• Emphasize the importance of adhering to the

prescribed schedule to maintain treatment efficacy.
• Advice on proper storage conditions for medications,
such as storing at room temperature, away from
direct sunlight or moisture, and keeping medications
out of reach of children.
• Inform the patient and the patient's family about the
MEDICATION take-home medication, including the drug's name,
use, recommended dosage, and timing for taking it in
accordance with the doctor's instructions.
• Instruct the patient not to miss doses and to take the
medication as prescribed.
• Inform the patient to call the doctor if he has any
negative side effects from the drug.
• A physical therapist can help you learn which
exercises are safe for you.
EXERCISE • Gentle stretching exercises can help maintain
flexibility and prevent stiffness in the lower body.
• Try to stay as active as you can.
• Emphasized the importance of regular follow-ups
and as instructed by physician.
• The patient must adhere to the medical advice given
after being released.
• Inform the patient of the goal of the at-home
TREATMENT treatment by providing information.
• Demonstrate how to administer the treatment in a
proper manner.
• If you experience any complications while taking
your medication, call your doctor or the nurse call
.line
• Emphasize the importance of maintaining good
personal hygiene practices, including regular bathing
or showering as needed, washing hands frequently,
and keeping the body clean to prevent infections.
HYGIENE • Instruct on proper skincare routines to prevent skin
breakdown and irritation.
• Advice on maintaining a comfortable room
temperature, using cooling products such as cooling
69
vests, towels, or fans to manage heat sensitivity, and
avoiding extreme temperature changes.
• Stress the importance of regular dental care and oral
hygiene practices, such as brushing teeth at least
twice a day, using dental floss, and attending dental
check-ups to prevent oral health issues.
• The patient should be told where and when to
schedule appointments for care.
• Encourage the patient to follow the doctor's
directions for a follow-up appointment in order to
OUTPATIENT safeguard the patient's well-being and avoid any
more issues.
• Explains to the patient the importance of follow-up
check-ups.
• Provide the patient directions on where and who to
contact if they need medical help.
• Consult with a licensed nutritionist. They can assist
you in creating an appropriate meal plan.
• Inform the patient of the rationale behind her
recommended diet.
DIET • Eat a well-balanced diet. Talk to your provider about
taking vitamins. If you have trouble swallowing, ask
what foods you should eat and what not to eat.
Nursing actions to help clients meet their spiritual needs
include:
• Encourage the patient to continue to seek God’s
guidance and enlightenment.
• Encourage open communication with healthcare
SPIRITUAL providers about spiritual needs or concerns.
• Assist the patient in finding hope and maintaining a
positive outlook.
• Encourage and support the patient in continuing or
engaging in spiritual practices that are important to
them.
70
BIBLIOGRAPHY
Bladder Dysfunction | Multiple Sclerosis Association of America MSAA (2023)
https://mymsaa.org/ms-information/symptoms/bladder-dysfunction/)
Dizziness and Vertigo in Multiple Sclerosis. Paul Frysh (2022)
https://www.webmd.com/multiple-sclerosis/managing-related-tremors
“Functional Neuroanatomy of the Basal Ganglia.” Cold Spring Harbor Perspectives in
Medicine, vol. 2, no. 12, 15 Oct. 2012, pp. a009621–a009621,
https://doi.org/10.1101/cshperspect.a009621.
Ignacio, K. H. D., Espiritu, A. I., & Jamora, R. D. G. (2020). The current status and
challenges in multiple sclerosis management in the Philippines. Multiple Sclerosis and Related
Disorders, 46, 102510. https://doi.org/10.1016/j.msard.2020.102510
Julie Stachowiack (2023). Numbness and Tingling With MS.
https://www.verywellhealth.com/numbness-tingling-in-ms-2440806)
Multiple Sclerosis (MS) Causes and Risk Factors - Healthline (2021)
https://www.healthline.com/health/multiple-sclerosis/possible-causes
Multiple Sclerosis: Facts, Statistics, and You. Healthline (2022)
https://www.healthline.com/health/multiple-sclerosis/facts-statistics-infographic
Multiple Sclerosis Risk Factors. Rare Disease Factors ( 2021)
https://www.rarediseaseadvisor.com/hcp-resource/multiple-sclerosis-risk-factors/
Multiple sclerosis - Symptoms and causes - Mayo Clinic. (2022, December 24). Mayo
Clinic. https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-
20350269
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Nazem Ghasemi et al. (2016). Multiple Sclerosis: Pathogenesis, Symptoms, Diagnoses
and Cell-Based Therapy https://pubmed.ncbi.nlm.nih.gov/28367411/
Prednisone: Uses, interactions, mechanism of action | DrugBank Online. (n.d.).
DrugBank. https://go.drugbank.com/drugs/DB00635
Wen-Juan H, Wei-Wei C, &., Xia Z. (2018).Multiple sclerosis: Pathology, diagnosis and
treatments.
https://doi.org/10.3892%2Fetm.2017.4410
Zhao, J., Chau, J. P. C., Lo, S. H. S., Choi, K. C., & Liang, S. (2021). The effects of
sitting Tai Chi on physical and psychosocial health outcomes among individuals with impaired
physical mobility: A systematic review and meta-analysis. International Journal of Nursing
Studies, 118, 103911. https://doi.org/10.1016/j.ijnurstu.2021.103911
Shipp S. Structure and function of the cerebral cortex.
Anatomy, Central Nervous System - StatPearls - NCBI Bookshelf
Spasticity and spasms. MSTrust (2021)
https://mstrust.org.uk/a-z/spasticity-and-spasms)
Thau, Lauren, et al. “Anatomy, Central Nervous System.” PubMed, StatPearls
Publishing, 10 Oct. 2022, www.ncbi.nlm.nih.gov/books/NBK542179/.
The hypothalamus: anatomy and functions. (1980, August 1). PubMed.
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TheMSResistance (2021)
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What causes MS? Is MS Hereditary or Genetic? MSSociety (2023)
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73

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DAVAO DOCTORS COLLEGE, INC.

General Malvar St., Davao City

A Case Study Presented to the Nursing Clinical Instructors

In Partial Fulfillment of the Requirements in

interventions to promote optimal well-being. Our knowledge and abilities in implementing an

appropriate and effective Nursing Process approach would be improved.

a. Create an introduction that provides a brief overview of the case study;

c. Develop specific, measurable, attainable, realistic, and time-bound (SMART) objectives to

serve as a guide for the completion of this study;

d. Investigate and explain the significance of diagnostic tests;

f. Research on the drug study of the medication given to our patient;

and health needs, using appropriate nursing interventions

j. Make a list of all the references used in the study.

(GBD 2016 Multiple Sclerosis Collaborators, 2016).

rheumatic conditions of patients.

informative resource that can supplement existing studies in nursing education.

Patient’s Name : Napoles, Angeline

Age : 39 year old

Birthday : April 29, 1984

Civil Status : Married

Birth Place : Mati, Davao Oriental

Address : Apokon, Tagum City, Davao del Norte

Occupation : Private Nurse

II. Clinical Data

Chief Complaint : Numbness of lower extremities

Time of Admission : 9:15 AM

Hospital : Davao Doctors Hospital

Room number : 3016

Attending Physician : Dr. Demegillo

VITAL SIGNS UPON ADMISSION RESULTS

Pulse Rate 87 bpm

Respiratory Rate 20 cpm

Blood Pressure 120/80 mmHg

Oxygen Saturation 97%

Pain Scale 8/10

III. Past Health History

past week and has been feeling progressively worse.

REVIEW OF ANATOMY AND PHYSIOLOGY

breathing and digestion.

release or inhibit antidiuretic hormone, corticotropin-releasing hormone, gonadotropin-releasing

hormone, growth hormone-releasing hormone, prolactin inhibiting hormone, thyroid releasing

hormone, and oxytocin.

medulla, and thalamus.

is smooth and coordinated.

Reticular formation: Reticular formation is an extensive network of pathways containing

information, as well as being sensory overloaded.

and smooth muscle to regulate both involuntary and voluntary reflexes.

securing the spinal cord from top to bottom.

neurons. These efferents neurons then produce muscle movement.

movement, emotions, communication, thought processing, and memory. It is protected by the

substances from entering.

by bone, meninges, and cerebrospinal fluids.

Localized areas of demyelination (plaques) occur, with destruction of oligodendroglia,

but to a much lesser degree.

exacerbations. When MS is not treated with immunomodulating medications, exacerbations

average about 1 every 2 years, but frequency varies greatly.

● Relapsing-remitting pattern: Exacerbations alternate with remissions, when partial or

Exacerbations can occur spontaneously or can be triggered by an infection such as

influenza. Relapsing forms of MS include active secondary MS (defined as a clinical

progress. Unlike in the relapsing-remitting pattern, there are no clear exacerbations.

remissions (relapsing-remitting pattern), followed by gradual progression of the

● Progressive relapsing pattern: The disease progresses gradually, but progression is