Med Surg Case Study #21: Multiple Sclerosis

Sharon James | 28 years old

Chief Complaint: Sharon presents with fatigue, weakness, and difficulty in coordination.

Medical History:

• Family history of multiple sclerosis (MS)

• No other significant medical history reported

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1000

Nurse's Note: Sharon reports feeling fatigued and weak, with difficulty in coordination over the past few weeks. She mentions a family history of MS. Neurological assessment reveals mild ataxia and decreased muscle strength in lower extremities.

Vital Signs:

• Blood pressure: 120/80 mmHg

• Heart rate: 75 bpm

• Respiratory rate: 16 breaths/min

• Temperature: 98.6°F (37°C)

Provider Orders:

• Perform neurological assessment.

• Order MRI of the brain and spinal cord.

• Start empirical treatment for fatigue with amantadine 100 mg orally twice daily.

1300

Nurse's Note:Mr. Sharon undergoes MRI imaging, which reveals multiple plaques consistent with demyelination in the brain and spinal cord. She reports worsening fatigue and mild paresthesias in her lower extremities.

Vital Signs

• Blood pressure: 118/76 mmHg

• Heart rate: 80 bpm

• Respiratory rate: 18 breaths/min

• Temperature: 98.8°F (37.1°C)

Provider Orders:

• Initiate treatment with interferon beta-1a (Rebif) subcutaneously every other day.

• Prescribe vitamin D supplements to optimize vitamin D levels.

• Educate patient on disease-modifying therapies and lifestyle modifications.

1630

Nurse's Note: Sharon experiences worsening weakness and numbness in her lower extremities. She also reports mild urinary urgency and frequency.

Vital Signs:

• Blood pressure: 122/78 mmHg

• Heart rate: 85 bpm

• Respiratory rate: 20 breaths/min

• Temperature: 98.9°F (37.2°C)
  

Provider Orders:

• Assess and monitor bladder function

• Give baclofen (Lioresal) 10 mg orally three times daily for spasticity.

• Consult with neurologist for further evaluation and management.

Question 1: What are the common presenting symptoms of multiple sclerosis (MS)?

Question 2: Why is vitamin D supplementation prescribed in patients with MS?

Question 3: What is the rationale behind initiating treatment with interferon beta-1a (Rebif)?

Answers to Questions Below

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Answers

Question 1: What are the common presenting symptoms of multiple sclerosis (MS)?

Common symptoms include fatigue, weakness, difficulty in coordination, sensory disturbances (such as numbness and tingling), visual disturbances, and bladder dysfunction.

Question 2: Why is vitamin D supplementation prescribed in patients with MS?

Vitamin D supplementation is often prescribed because there is evidence to suggest that low levels of vitamin D may be associated with an increased risk of developing MS and may also contribute to disease progression. Additionally, optimizing vitamin D levels may help modulate the immune response and reduce disease activity.

Question 3: What is the rationale behind initiating treatment with interferon beta-1a (Rebif)?

Interferon beta-1a is a disease-modifying therapy used to reduce the frequency and severity of relapses in relapsing forms of MS. It helps modulate the immune response and reduces inflammation in the central nervous system, thereby slowing disease progression and reducing the formation of new lesions.

Med Surg Case Study