NRSG 265 :Health Consumer Perspective on Medical Alterations

Subject Name : Medical Science

Justification and epidemiology

The chosen disease is Multiple Sclerosis (MS). I selected MS based on the provided information about a 35-year-old female of Irish background recently diagnosed with MS, along with her family history of the disease (her father). MS is a complex autoimmune neurological disorder with a significant impact on quality of life (Stoiloudis et al., 2021). This choice is relevant to the patient's situation, allowing her to make informed healthcare decisions and understand potential genetic factors. From 103.7 per 100,000 persons in 2017 to 131.1 per 100,000 people in 2021, MS prevalence increased in Australia. Moreover, 33,335 individuals had MS as of 2021. In comparison to 2017, there has been an increase of 7,728 individuals (from 25,607 individuals) (MS Australia, 2023). Given the patient's Irish background, understanding epidemiology in Australia is vital, as it helps healthcare planning, early diagnosis, genetic counselling, research, and patient empowerment. This focus is crucial for personalised care and broader public health implications, making it relevant both on an individual and societal level.

Pathophysiology

The central nervous system (CNS) is the main target of the complex and incapacitating chronic autoimmune illness known as multiple sclerosis (MS). The myelin coating that surrounds nerve fibres in the CNS is destroyed, which is a defining characteristic of the disease (Faissner et al., 2019). A wide range of neurological symptoms that differ from person to person are brought on by this demyelination, which interferes with the regular passage of nerve signals. It is essential to comprehend the pathophysiology of MS in order to create successful interventions and treatments (Stys & Tsutsui, 2019). Although the precise origin of MS is still unknown, an autoimmune reaction is thought to be a contributing factor. This implies that the immune system unintentionally targets CNS components for unknown reasons. Research is undertaken to determine which genetic and environmental variables, if any, contribute to this autoimmune reaction (DeMaio et al., 2022).

The infiltration of immune cells, in particular T lymphocytes, over the blood-brain barrier and into the central nervous system (CNS) is one of the critical mechanisms in the pathogenesis of MS. These immune cells get activated once they are within the CNS and start an inflammatory cascade (Kamma et al., 2022). Microglia and macrophages are stimulated by this inflammation, and they release pro-inflammatory chemicals such as cytokines and chemokines. These signalling molecules cause the CNS's afflicted regions to attract more immune cells, which leads to the development of inflammatory lesions or plaques (Huang et al., 2020). The defining effect of this inflammation is demyelination. The myelin sheath is damaged by inflammatory reactions, which causes the nerve fibres to lose their myelin sheath. Due to the disruption of normal nerve impulse conduction, a variety of neurological symptoms, including weakness and issues with coordination (Manjaly et al., 2019)

MS can directly harm nerve fibres (axons), in addition to demyelination. This axonal damage, which can lead to an irreversible loss of nerve function, is a substantial contribution to the progressive impairment seen in some cases of MS. The cells that produce myelin, called oligodendrocytes, may try to remyelinate in the early stages of the disease (Gajamange et al., 2018). These repair mechanisms, however, frequently fall short, causing incomplete remyelination and the development of scar tissue in the central nervous system (CNS). Neurodegeneration can develop over time as a result of persistent inflammation and repeated episodes of demyelination and remyelination. The gradual disability that some MS sufferers experience is a result of this process (Piehl, 2021).

Lastly, because MS is a diverse disease, each person will experience the disease's course and symptoms differently. Relapsing-remitting MS is a pattern in which some people experience relapses followed by intervals of remission, whereas primary progressive MS is a pattern in which people experience progressively advancing symptoms (Hauser & Cree, 2020). Environmental factors also contribute to the onset and development of MS. Smoking, infections, and vitamin D deficiency have all been linked to a higher chance of having MS or making its symptoms worse. The complicated interplay of genetics and environment in MS pathophysiology is highlighted by the possibility that these environmental factors could combine with genetic predisposition to cause the disease (Waubant et al., 2019).

Pharmacology

Disease-modifying therapies (DMTs) are a class of drugs that are frequently used to treat Multiple Sclerosis (MS), and interferon-beta (IFN-beta) is one of their famous members (Ciotti et al., 2020). IFN-beta works through a number of different mechanisms, but it primarily functions as an anti-inflammatory drug by lowering immune cell activity and tamping down the autoimmune reaction inside the central nervous system. Additionally, it might aid in restoring stability to the blood-brain barrier, preventing immune cells from penetrating the system (Jakimovski et al., 2018). Since secondary progressive MS (SPMS) with relapses and relapsing-remitting MS (RRMS) are both relapsing forms of MS that are suggested for treatment with interferon-beta, they are compatible with the patient's RRMS diagnosis. Its effectiveness in treating primary progressive MS (PPMS) is still unknown (Bayas et al., 2023). The patient's desired injection technique (intramuscular or subcutaneous), monitoring requirements, potential adverse effects (including flu-like symptoms), and family history should all be taken into account when deciding whether to use IFN-beta (Filipi & Jack, 2020).

Ultimately, MS is a complex disorder that includes CNS neurodegeneration, immune responses, inflammation, and demyelination. While there is still much to learn about the precise mechanisms and causes of MS, it is crucial to understand its pathophysiology in order to create specialised therapies and care plans for this challenging condition. It is crucial to successfully manage the pathophysiological changes brought on by MS, reduce the frequency of relapses, and slow the progression of the illness in order to enhance the patient's overall quality of life.

Impact of chronic disease

The effects of MS on the body are frequently the most noticeable. Due to the disease's primary focus on the central nervous system, a wide range of physical symptoms that can differ from person to person can be experienced. These signs may include coordination issues, tingling, numbness, and muscle weakness (Lakin et al., 2020). Such neurological symptoms can interfere with daily tasks, limit mobility, and put a person's independence at risk. Mobility problems may worsen as the illness advances, necessitating the use of devices like canes, walkers, or wheelchairs (Cameron & Nilsagard, 2017).

Muscle spasms, neuropathic pain, and musculoskeletal pain are just a few of the several types of pain that MS can bring on. These pains add to physical discomfort and lower quality of life (Mitsikostas et al., 2022). Secondly, MS has a substantial emotional toll, which frequently overlaps with physical difficulties. Managing a chronic and unpredictable illness like MS might result in depressive and anxious thoughts. These mood disorders may make physical symptoms worse, which makes it difficult to break the vicious cycle (Hanna & Strober, 2020). The ongoing attention required to manage MS results in frequent doctor visits, difficult prescription regimens, and lifestyle modifications, all of which put the patient and their family under stress. The emotional health of a patient might be negatively impacted by cognitive changes, such as memory issues and trouble focusing, which can lower self-esteem and confidence (Schlegel & Leray, 2018).

A patient's life might be significantly disrupted by MS on the social front. Social isolation may occur from symptoms' unexpected nature, incapacitating exhaustion, and mobility problems. Patients could find it more and more challenging to engage in social activities or keep up regular social interactions, which can result in feelings of isolation and a sensation of being cut off from society (Jaime-Lara et al., 2020). Employment can also be difficult because many MS sufferers find it difficult to keep their jobs owing to physical and mental impairments. Financial stress and self-esteem issues might arise from job loss or reduced working hours, adding to the emotional burden (Raggi et al., 2019).

Additionally, MS can strain relationships because it calls for modifications and support from partners and family members. Caregiving can be a tough job, which can cause a caregiver burden and weaken family ties. The difficulties faced by people with MS and their loved ones are complicated further by the intricate interplay of social forces (Maguire & Maguire, 2020). Finally, it is important not to undervalue MS's financial effects. MS management can be expensive, with costs for prescription drugs, doctor visits, physical therapy, and assistive technology. These fees may be quite expensive for individuals and their families in nations with insufficient healthcare coverage (Marziniak et al., 2018).

Long-term management and health promotion strategies

For people with Multiple Sclerosis (MS), long-term management plans are essential to enhancing their health, independence, and general quality of life. These approaches take a comprehensive approach, taking into account the disease's numerous financial, social, emotional, and physical aspects (Wills & Probst, 2022). First, a key component of MS care, disease-modifying medicines (DMTs), have demonstrated their effectiveness in several clinical studies by lowering relapse rates, slowing disease progression, and enhancing overall outcomes. Medications for spasticity and exhaustion are examples of symptom management techniques that are supported by clinical guidelines and offer recommendations based on available data. Studies have shown that physical and occupational therapy improves walking skills and balance, which contributes to improved mobility and quality of life. Cognitive-behavioural therapy and support groups are two psychological support therapies that have been shown helpful in lowering depressive and anxiety symptoms in MS patients. Research showing its capacity to enhance physical function and lessen weariness supports the significance of a healthy lifestyle, including regular exercise and dietary changes. Additionally, clinical research and real-world experience support the use of assistive technology, social support systems, vocational rehabilitation programs, and financial planning techniques in enhancing different areas of MS patients' lives.

Justification of nursing care

According to research by Cerqueira et al. (2018), timely DMT introduction can have a major impact on the disease, preserve neurological function, and improve the patient's quality of life. DMTs can improve long-term results when they are started early in the illness course. Interferons, glatiramer acetate, and more recent medications like ocrelizumab are examples of medicines that function by modifying the immune system's response and lowering inflammation in the central nervous system (Giovannoni, 2018). A complementary role in accomplishing this goal is played by lifestyle changes as well. For those with MS, eating a balanced diet and exercising frequently have been linked to greater overall well-being. These lifestyle choices may lead to greater physical health, more effective MS symptom treatment, and an overall higher quality of life (Strober et al., 2018). In order to minimise inflammation and hasten the recovery of symptoms, high-dose corticosteroids are frequently utilised, such as intravenous methylprednisolone. Early corticosteroid therapy has been linked to better results and a quicker recovery to baseline functioning (Racke et al., 2022).

In order to maintain muscle strength and function and prevent impairment, physical treatment is crucial during acute exacerbations. Physical therapists can create specialised exercise regimens to target particular complaints and help people regain mobility and independence as soon as feasible (Teoduru et al., 2019). Comprehensive care also involves emotional and psychological assistance during acute exacerbations. Acute exacerbations can have a significant psychological impact since they might disturb daily living and create distress (Fisher et al., 2020). Lastly, counselling and emotional support can assist patients in coping with the disease's physical and psychological effects (Davis et al., 2021).

References

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Cameron, M. H., & Nilsagard, Y. (2017). Balance, gait, and falls in multiple sclerosis. Handbook of Clinical Neurology, 159, 237-250. https://doi.org/10.1016/B978-0-444-63916-5.00015-X

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