NURS 6501 Week 7 Assignment Neurological Disorders

• NURS 6501 Week 7 Assignment Neurological Disorders

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Walden University

NURS 6501

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Neurological Disorders – Concept Map

Primary Diagnosis: Multiple Sclerosis

1. Describe the pathophysiology of the primary diagnosis in your own words. What are the patient’s risk factors for this diagnosis?

Pathophysiology of Primary Diagnosis
Multiple Sclerosis (MS) is a disorder that involves the central nervous system (CNS), particularly the brain, the spinal cord, and the optic nerves. Abnormal immune response in MS wrongly attacks the myelin sheath, or coating of nerve fibers, its pathophysiology. In healthy individuals, the myelin sheath keeps nerve fibers safe and enhances the transmission of neuronal impulses. The immune system attacks myelin in MS, resulting in inflammation and damage. This is referred to as the demyelination process.Neurological symptoms are caused by impairment of the transmission of electrical impulses by myelin. There are a variety of immunological responses that lead to scar tissue or plaques (sclerotic lesions) in the CNS. These plaques are found with MRIs, which is a typical feature of MS. Genetic predisposition and environmental influences, including virus infections or vitamin D deficiency, are the possible causes of the autoimmune response in MS. The most common type of MS is relapsing-remitting MS (RRMS), which is associated with new or exacerbating symptoms and recovery (partial or full) (Giovannoni et al., 2022). Other MS are secondary progressive MS (SPMS), which begins as a relapsing-remitting disease but evolves into a progressive one without any relapses and remissions, and the primary progressive MS (PPMS), which manifests the symptoms gradually and progressively since its beginning without relapses and remissions.
Causes	Risk Factors (genetic/ethnic/physical)
The exact etiology of MS has not been known, but it is suspected to be a complex disease that is induced by genetic as well as environmental factors. Genetic predisposition is a factor, as individuals who have a family history of MS or other autoimmune diseases are at risk. There are a number of genes, in particular, the regulators of the immune system, which make MS more dangerous.The environment also plays a part in MS development. Latitude is considered to be one of the most established environmental risk factors, more frequent in remote locations. As vitamin D is an immune system modulator, sunshine and vitamin D concentrations could influence the risk of MS. Viral infections, including Epstein-Barr virus (EBV), are known to increase the risk of MS (Ahmed et al., 2019). The method is that the virus particles are coated with proteins of the myelin to trigger an autoimmune response. Other potential factors are smoking, which predisposes to MS and makes the condition progress faster, and obesity, particularly among adolescents. In general, MS is immunologically brought about by genetic susceptibility and the environment.	There are several risk factors of Multiple Sclerosis that encompass genetic and ethnic factors as well as physical factors. Genetic factors, such as a parent or a sibling with MS, are risk factors. Variations of the human leukocyte antigen (HLA) complexes were found to be associated with MS susceptibility (Lysandropoulos et al., 2019). Risk is influenced by ethnic background, with Northern Europeans being more prone to MS compared to the Asian, African, or Native Americans. Physical factors include environmental factors such as latitude and the levels of vitamin D. Residents of high latitudes receiving less sunshine were more likely to have MS, which may be due to vitamin D deficiency. The immune system’s reactions to viruses such as the Epstein-Barr virus may cause MS by triggering myelin autoimmune reactions (Ahmed et al., 2019). Smoking increases the risk of MS and hastens the progression of MS. Obesity (particularly in adolescents) can contribute to MS risk because it has pro-inflammatory effects.

Signs and Symptoms – Common presentation

Complications?

The signs and symptoms of Multiple Sclerosis depend on the CNS involvement. Weariness is one of the worst symptoms of MS. This fatigue is at times out of proportion to actions and could be a hindrance to normal living. Another symptom is sensory issues in the form of numbness or tingling in the limbs, face, or body (Freiha et al., 2020). Spotty sensory changes could be either temporary or permanent.Motor symptoms consist of muscle weakness, spasticity, coordination, and balance problems. This may complicate walking and day-to-day activities. MS frequently leads to eye issues such as optic neuritis that might lead to poor vision, vision loss in a single eye, or difficulty in movement. There may be diplopia and nystagmus. Issues with cognitive functioning, such as memory, attention, and executive functioning, are common in MS patients. It is possible that cognitive deficiencies will impact work and social life. Despair and anxiety are some of the common emotional changes in MS that may interfere with the treatment process of the disease. Symptoms of bladder and bowel dysfunctions, such as urine urgency, frequency, incontinence, and constipation, are common and reduce the quality of life.

Multiple Sclerosis presents numerous challenges in that it impacts many body systems. MS symptoms are caused by demyelination and disturbance of nerve signals in the nervous system. It may result in chronic pain, sensory impairments, muscle weakness, and rigidity. The nerve damage and paralysis can occur due to multiple assaults.The musculoskeletal system may be weak and spastic, which may hinder movement and predispose one to fractures. Long-term immobility can lead to muscle atrophy and joint contractures. Poor mobility and sedentary lifestyles could predispose to cardiovascular diseases like hypertension and coronary artery disease, which indirectly influence the cardiovascular system. Bowel dysfunction caused by MS is able to impair the gastrointestinal system, leading to constipation or fecal incontinence (Langston et al., 2021). These conditions may reduce the quality of life and need constant attention. UTIs: Bladder dysfunction results in urine urgency, frequency, incontinence, and increased risk of UTIs.MS can also impair the respiratory system and lung capacity, as well as make someone susceptible to respiratory infections. The cognitive and psychological effects are devastating, and most patients experience cognitive impairment, depression, and anxiety. Mental illnesses may inhibit the quality of life and management of illness.

3. What are other potential diagnoses that present in a similar way to this diagnosis (differentials)?

NMO differs from MS treatment because it rarely leads to lesions in the brain. Acute Disseminated Encephalomyelitis (ADEM) is another diagnosis, as it is an acute inflammation of the brain and spinal cord post-viral infection or immunization (Filippi & Rocca, 2020). ADEM shares some of the neurological symptoms, but it is monophasic as compared to MS, which is chronic and recurrent.Lupus and other autoimmune conditions may mimic the symptoms of MS, particularly CNS-related symptoms (Wildner et al., 2020). MS can be accompanied by fatigue, impairments in cognition and neurological abnormalities, and to differentiate the two, vigorous examination and testing are necessary. Borrelia burgdorferi-caused Lyme disease is an MS-like neurological disease that presents itself in the form of fatigue, muscle weakness, and cognitive impairments (Ilchovska, 2024). Diagnosis requires a detailed patient history, including exposure to ticks, and special serological tests. The brain damage caused by cerebral small vessel disease that damages brain blood vessels may lead to MS-like symptoms, including cognitive impairments, motor issues, and balance problems. MRI is able to distinguish these conditions. Besides, the deficiency of vitamin B12 may lead to such neurological symptoms as numbness, tingling, and cognitive impairment. The diagnosis requires vitamin B12 blood tests.

The diagnosis of Multiple Sclerosis and elimination of other diseases are determined by a number of diagnostic tests and labs. The most important MS imaging technique is MRI, as it could reveal brain and spinal cord demyelinating lesions (Filippi et al., 2019). MS is diagnosed by periventricular, juxtacortical, infratentorial, and spinal cord lesions. Active inflammation can be viewed using gadolinium-enhanced MRI as enhancing lesions.To test CSF oligoclonal bands, a lumbar puncture is performed to test the CSF, showing an abnormal immune response in the CNS. Diagnosis of MS based on oligoclonal bands in CSF but not in blood. Evoked potential tests are tests that monitor electrical activity in the brain in reaction to sensory stimulus, i.e., visual, auditory, and somatosensory evoked potentials (VEP). These tests are able to reveal neural route electrical conduction issues even in the absence of symptoms. Blood tests eliminate infections, shortages of different vitamins, and autoimmune diseases that can be similar to MS. NMO can be differentiated by testing aquaporin-4 antibodies. Alternative causes of symptoms can be noted by complete blood count (CBC), comprehensive metabolic panel (CMP), and thyroid function tests.

5. What treatment options would you consider? Include possible referrals and medications.

These medicines reduce inflammation and damage to the myelin. Common DMTs are interferon-beta, glatiramer acetate, natalizumab, fingolimod, dimethyl fumarate, and ocrelizumab. All of these drugs possess varying mechanisms of action, and their possible side effects, the course of the disease, reaction to previous treatments, and tolerance to side effects of the patient define the treatment.Corticosteroids, such as methylprednisolone, reduce the inflammation and accelerate recovery in cases of acute relapses (Talanki Manjunatha et al., 2022). In severe cases, the use of corticosteroids is not effective, and plasma exchange (plasmapheresis) can be attempted. Symptomatic treatment is also part of MS management. The spasticity is treated with muscle relaxants, such as baclofen and tizanidine, and neuropathic pain is treated with drugs such as gabapentin and pregabalin. Fatigue can be controlled using lifestyle changes, such as energy conservation, and drugs such as amantadine or modafinil.Physical therapy is essential in the management of spasticity, the management of muscular weakness, and the maintenance of mobility. Occupational therapy assists patients in dealing with their physical disability and helps them perform their daily tasks. Speech therapy is important to individuals with problems with swallowing and speaking. Cognitive rehabilitation enhances the mental capacity and treats mental disorders. There should be psychiatric treatment and support groups to deal with MS-related sadness and anxiety.To have an entire MS management, referrals to experts are normally necessary. MS-specialized neurologists are able to monitor and modify treatment. Physical, occupational, and speech therapists play a key role in recovery. Urologists are doctors who cure bladder problems, gastroenterologists bowel problems. Social workers can assist patients in navigating healthcare systems and locating resources, and psychiatrists and psychologists can enhance mental health.

References

Ahmed, S. I., Aziz, K., Gul, A., Samar, S. S., & Bareeqa, S. B. (2019). Risk of Multiple Sclerosis in Epstein–Barr Virus Infection. Cureus. https://doi.org/10.7759/cureus.5699

Filippi, M., Preziosa, P., Banwell, B. L., Barkhof, F., Ciccarelli, O., De Stefano, N., Geurts, J. J. G., Paul, F., Reich, D. S., Toosy, A. T., Traboulsee, A., Wattjes, M. P., Yousry, T. A., Gass, A., Lubetzki, C., Weinshenker, B. G., & Rocca, M. A. (2019). Brain, 142(7), 1858–1875. https://doi.org/10.1093/brain/awz144

Filippi, M., & Rocca, M. A. (2020). Acute disseminated encephalomyelitis. White Matter Diseases, 109–125. https://doi.org/10.1007/978-3-030-38621-4_5

Freiha, J., Riachi, N., Chalah, M. A., Zoghaib, R., Ayache, S. S., & Ahdab, R. (2020). Journal of Clinical Medicine, 9(10), 3100. https://doi.org/10.3390/jcm9103100

Smouldering multiple sclerosis: the “real MS.” Therapeutic Advances in Neurological Disorders, 15, 175628642110667. https://doi.org/10.1177/17562864211066751

Ilchovska, D. (2024). Lyme disease and autoimmune diseases. Elsevier EBooks, 473–488. https://doi.org/10.1016/b978-0-323-99130-8.00041-6

Langston, C., Fabian, M., & Krieger, S. (2021). Symptom management in multiple sclerosis. Springer EBooks, 507–521. https://doi.org/10.1007/978-3-030-61883-4_32

Lysandropoulos, A. P., Perrotta, G., Billiet, T., Ribbens, A., Renaud Du Pasquier, Caroline Pot Kreis, Maggi, P., & Théaudin, M. (2019). Canadian Journal of Neurological Sciences, 47(2), 189–196. https://doi.org/10.1017/cjn.2019.329

Manouchehri, N., Salinas, V. H., Rabi Yeganeh, N., Pitt, D., Hussain, R. Z., & Stuve, O. (2022). Efficacy of disease-modifying therapies in progressive MS and how immune senescence may explain their failure. Frontiers in Neurology, 13. https://doi.org/10.3389/fneur.2022.854390

Talanki Manjunatha, R., Habib, S., Sangaraju, S. L., Yepez, D., & Grandes, X. A. (2022). Multiple sclerosis: therapeutic strategies on the horizon. Cureus, 14(5). https://doi.org/10.7759/cureus.24895

Related assignment for this class : NURS 6501 Week 5 Assignment