Epilepsy

Abigail LeeMultiple Sclerosis

Rationale for Chosen TopicDetermining appropriate mobility assistive technology (MAT) for patients with physical disability due to Multiple Sclerosis (MS).

IntroductionPurpose Statement

Identifying factors that effect the choice of MAT for patients with MS and what MAT options are available.

Evidence for CarePathophysiologyClinical ManifestationsNursing ConsiderationsAnd finally (Smeltzer, Bare,Hinkle,Cheever, 2010, p. 1956-1962)

Evidence for CareDorothea Orems Self-Care Theory(Maville, Huerta, 2013, p. 33)

Evaluation of EvidenceMethodsUsed multiple key words in searchConcerning MS patients with impaired mobilityPeer-reviewedResultsMultiple MAT choice factorsLimited number of higher levels of evidenceRecommendations(Souza, Kelleher,Cooper,Cooper,Iezzoni,Collins, 2010)

Evaluation of Evidence Article CritiqueLevel of EvidenceLimitations

(Souza, Kelleher,Cooper,Cooper,Iezzoni,Collins, 2010)

Patient Care DesignTRUEPIC1. Identify

26 yom

No significant medical history

Experiencing numbness, tingling, loss of balance, and lack of coordination

Works as a school teacher

Active lifestyle

Fear of MS diagnosis

2. RelatePrimary Proposition:Pt is experiencing an onset of MS as evidenced by symptoms and family history.Possible Assumptions:Pt understands the process of MS on the body because of family history.Possible Confounding Variables:Pt is fearful of complications of MS.

3. UnderstandProposition:Pt is showing symptoms associated with MS, however, further testing should be completed. Significance of Assumptions:If pt does not understand the process of MS, he may miss significant education on the disease. Possible Confounding Variables:Pt may not know treatment options for patients with MS causes him to be fearful of a diagnosis.Situation: Steve is a 26 yom who has come to the clinic after a recent onset of numbness and tingling in his extremities, a noted loss of balance, and has felt unusually clumsy. He has no significant medical history. He lives an active lifestyle and works as a grade school teacher. He is married with no children. He is accompanied by his wife, Sara, who is concerned because of Steves family history of Multiple Sclerosis. Steve appears anxious and states he is fearful of an MS diagnosis because he wont be able to live the same lifestyle he has now.

Patient Care DesignTRUEPIC continued

4. ExplainProposition:In a way meaningful to the pt, explain symptoms, diagnosis, and treatment of MS.Assumptions:Give a thorough explain of MS even if the pt already has background regarding the disease and answer questions.Confounding Variables:Explain the benefits of different treatment options and how to help maintain current lifestyle. 5. PredictProposition:If pt does have a diagnosis of MS, it is important to then provide information regarding MS treatment and self-care.Assumptions:Pt will understand the process of MS. Confounding Variables:If pt fear of a diagnosis of MS can be resolved, then an appropriate treatment plan can be set with goals and collaboration.6. InfluenceProposition:Make sure the pt understands what is necessary to complete a diagnosis of MS.Assumptions:Make sure the patient understands the process, symptoms, complications, and treatment if MS is diagnosed. Confounding Variables:Share treatment options that may be helpful in maintaining quality of life and the pts current lifestyle.7. Control-Pt will understand the process of MS-Pt will state treatment options that are available-Pt will set goals and keep appointments for MS treatmentNursing Diagnosis for MS:1. Impaired physical mobility r/t neuromuscular impairment2. Self-care deficit r/t neuromuscular impairment3. Risk for injury r/t sensory dysfunction and impaired mobility

(Ladwig, Ackley, 2011, p. 99)

Advocate RoleMATAssess patients individually to find an appropriate MAT for their lifestyleSymptomsPainPhysical healthOthers

Advocate RoleSignificance to Nursing Practice and Care

ReferencesLadwig,G.B., & Ackley,B.J. (2011). Mosby's guide to nursing diagnosis (3rded.). Maryland Heights, MO: Mosby. Maville,J.A., & Huerta,C.G. (2013). Nursing concepts and health promotion. In Health Promotion in Nursing (3rded., pp.32-34).Clifton Park, NY: Delmar.Smeltzer,S.C., Bare,B.G., Hinkle,J.L., & Cheever,K.H. (2010). Management of patients with neurologic infections, autoimmune disorders, and neuropathies. In Medical-Surgical Nursing(12thed., pp.1956-1962). Philadelphia, PA: Wolters Kluwer Health.Souza,A., Kelleher,A., Cooper,R., Cooper,R.A., Iezzoni,L.I., & Collins,D.M. (2010).Multiple sclerosis and mobility-related assistive technology: systematic review ofliterature. Journal of Rehabilitation Research & Development, 47(3), 213-23. Retrieved from http://0-dx.doi.org.libcat.ferris.edu/10.1682/JRRD.2009.07.0096