Long-term Neurologic Issues
On June 18, 2021 at 4:30 in the afternoon a 45-year-old woman named Maria came to the hospital due to her long-term neurologic issues. The patient describes how she had noted substantial alterations in neurologic functioning for many years, specifically heat intolerance, which resulted in a faltering stride and a tendency to fall.
Over the course of several years, her visual acuity seemed to fluctuate as well. The patient was working very hard and was under a lot of stress two months ago. Her neurologic state deteriorated after she became ill with the flu. She couldn’t grasp anything in her hands and had substantial tremors, and was extremely tired at the time. She suffered a few serious falls as well. She had experienced arthralgia on the right and then the left side of her body since then. After several days of employment, the patient acquired an acute right hemisensory impairment.
At the time, an MRI scan revealed multifocal white matter pathology, defined as areas of elevated T2 signal in both cerebral hemispheres. A spinal tap was also performed, which revealed oligoclonal bands in the CSF. With delayed conduction in the optic nerves, visual evoked response testing was abnormal. As of this moment, the patient is still weak and numb on her right side, has impaired urinary bladder function that necessitates numerous empties in the mornings, and suffers from nocturia three times a night. She developed incontinence and now requires the use of a pad during the day. She also experiences recurrent balance issues and a spinning sensation, as well as being excessively tired.
The patient shows difficulty for aspirating both liquids and solids. She has a persistent tinnitus that is connected with hearing loss and is more prominent on the left side. She has diminished finger dexterity and hand weakness on both sides. She also has short-term memory problems and is irritable. The doctor orders an IV infusion of D5LR 1000 mL to infuse over the next 8 hours. The IV set delivers 15 gtt/min.
FAMILY HISTORY
The aeg had a history of high blood pressure, cancer and heart disease.
PAST HISTORY
The aeg verbalized that she experienced mumps and chicken pox as a child. Later in life, she had anemia and allergies with hives. A tubal ligation was also performed on her.
NEUROLOGIC EXAMINATION
In the arms, deep tendon reflexes are +2 and symmetrical, whereas at the ankles and knees, they are +3. Extensor toe signs on both sides are visible On sensory examination, there is paresthesia to touch on the right side, as well as diminished pin sensation on the right side. In the distal lower extremities, the patient experiences modest vibratory sensory loss. Romberg’s test is negative. The attending physician order the following medications Decadron 0.5 mg PO every 6 hours for 48 hours Avonex 30 mcg IM once a week Baclofen 5 mg PO three times per day. Diazepam 10 mg PO 2 times a day. Urecholine 50 mg four times a day.
WRITTEN OUTPUT
1. Illustrate the pathophysiology of the case (Illustrate it in a Diagram form)
a. Book-based pathophysiology
b. Patient-based pathophysioloy
2. Formulate ONE nursing care plan (USING NCP FORMAT) based from the problem identified. problems identified.