Homeostasis.

This function depends on the ability of the nervous system to detect,

interpret, and respond to changes in internal and external conditions. It can help
stimulate or inhibit the activities of other systems to help maintain a constant
internal environment.

THE MYELIN SHEATH

A myelin sheath is a sleeve (sheath) that’s wrapped around each nerve cell
(neurons). It’s a protective layer of fat (lipids) and protein that coats the main
“body” section of a neuron called the axon.
ASSESSMENT OF THE PATIENT WITH MULTIPLE SCLEROSIS
Health management/perception:
Question -When was the onset of this illness and what symptoms did it present
with?
ANS:13th July 2023

Question - Did you use any self medication or you reported to the hospital?
ANS: reported to the hospital

Question - Has anyone in your family ever been diagnosed of this disease before ?
ANS – No

Nutritional Patterns:
Q- What type of food do you like and eat the most? Presently do you have appetite
for food? How often do you take water?
ANS – solid food
Takes water often

.
Elimination Patterns:
Q- how often do you open your bowl and urinate in a day? Do you use laxative?
Do you have pain during defecation or urination? Do you experience abnormal
vaginal discharge?
ANS –she does not make use of laxative
No pain during defecation
Normal vaginal discharge
She is experiencing urinary incontinence

Exercise/Activity Pattern:
Q- What do you do for a living? Do you do any form of exercise? Do you
experience any difficulty in breathing when carrying out your exercises?
ANS- she is a fashion designer
She has no difficulty in breathing
Sleep/Rest Pattern:
Q- How long do you sleep at night? Do you find it difficult sleeping at night? Do
you feel rested when you wake up in the morning? Do you take sleep including
drugs?
ANS-. She finds it difficult to sleep and sometimes takes cenpain night to induce
sleep

Cognitive/Perceptual Pattern:
Q- Do you have any difficulty in seeing, hearing, smelling, feeling or tasting? Do
you remember events and easily and clearly?
ANS-
She experienced blurred vision but other senses were normal

Self Image Perception:

Q- How do you feel about yourself since the onset of this illness? Does this illness
affect your attitude towards life and your self image?
ANS- she felt discouraged at first but accepted her faith later on

Sexuality/Reproductive Pattern:
Q- when did you experience menarche? have you had any sexual exposure? Have
you been sexually abused? Are you married? How many sexual partners do you
have? how many children, any miscarriages or abortions? do you use any means of
family planning? how has this illness affected your sexuality?

ANS- she have never been sexually abused.

She have four children, no history of miscarriage or abortion
She was on family planning

Role Relationship Pattern:

Q- Are you married? For how long? Do you relate well with your family
members?
How does your family feel about your illness?
ANS-she has been married for more than 25 years and relate well with her family
members
Her family members have been supportive, she was brought to the hospital by her
husband

Coping/Stress Tolerance Pattern:

Q- Does this illness pose as a threat or stress on you? what are your usual ways of
coping with stress?
ANS- No

Value/Belief Pattern:
Q- what do you value most? Do you believe in God? What is your religious
affiliation? is there any treatment regimen that contradicts your belief?
ANS-she believe in God and she is also a Christian

Laboratory and Diagnostic results

Diagnostic investigation
Blood count
Blood grouping and cross matching
White blood count (WBC)
Proper physical examination
Urinalysis
History taking
Cardiovascular: Regular rate and rhythm no murmur or gallops appreciated
Respiration: Clear to auscultation bilaterally
Neurological: Gross intact
investigation patient value normal value

WBC 10,500 mm3 3.5 -10,000mm3

Aspartataamino 35 units 10-40 unit

transferase (AST)

PVC 50 35-54%

Haemoglobin estimation 12.5 11.3-18.0g/dl

Red blood count 4.2 million mm3 3.8-5.8 million mm3

Platelets 25,000 cells/mm3 150-4,000 cells/mm3

potassium 3.8mEq/l 3.5-5 mEq/l

Sodium 138mEq/l 135 -145mEq/l

Chloride 102 mEq/l 90-110mEq/l

Bicarbonate 24mol/l 23-34 mol/l

Alanineamino transferase 25 units 5.35 units

(ALT)

AB A,B,AB and O

URINALYSIS

INVESTIGATION PATIENT VALUE NORMAL VALUE

Color Amber Amber

Amount 700mls 800-1500mls

Specific gravity 1.020 1.020-1.025

Deposit Nil Nil

 odor Normal Normal

Reaction Acidic Acidic

Abnormalities Nil Nil

NURSING MANAGEMENT
The aim of nursing management is to
Reduce pain
Improve physical functioning
Reduce psychological distress
Improve overall quality of life

ADMISSION
Admitted patient into a female medical ward
Ensured that the environment is cool and cam
Appropriate bed was made

MEDICAL MANAGEMENT
Natalizumab IV 300mg every four weeks
Fingolimoda tab 0.5mg 12hrly x 14 days
Baclofen tab 5mg TID x 7 days
Paracetamol IM x TID x 3 days
Modafinil tab 100mg 12hrly x 14 days

SUBSEQUENT MANAGEMENT
1st day
Patient was observed to be in pain. Doctor A.Z gave paracetamol intramuscularly
her vital signs read respiration 22b/m, blood pressure 110/80,temperature 36.7•c,
pulse 70b/m Patients was served warm and attractive food.

2nd day
Patient woke up in the morning with complain of muscle weakness and she was
reassured that after taking her drugs that is going to reduce. Vital signs at 6:00 am
read temperature 37•c, pulse 90b/m, Respiration 20b/m, At 8:00am her morning
food was given followed by her drug

3rd day
Mrs Enyinnaya woke up with slight fever
Her 6:00am vital signs read temperature 38.2•c,pulse 90b/m, blood pressure
120/90mmHg
She was exposed and her fan was turn on. Tepid sponging was carried out on her
The temperature was recheck after 30 minutes and it’s read 38.2•c patient was
tepid sponge further. After 1 hour, the temperature read 37•c. Her due drug was
served

4th day
Mrs Enyinnaya complained of urine in continuous Palpitation was carried out on
her bladder and she was taught bowel training. At 6:00 am, her temperature read
37•c,pulse 98b/m, respiration 24b/m, blood pressure 120/90mmHgAt 8:00am, her
morning good was served and her drugs was also given

5th day
Mrs Enyinnaya woke up with a smile on her face. She was looking better. Vital
signs at 6:00am reads temperature 38.5•c, pulse 100 b/m respiration 20b/m and
blood pressure 110/70 mmHg. She had her drug and personal hygiene was
maintained

6th day
Mrs Enyinnaya woke up and was looking strong. Her vitals sign at 6:00 am read
temperature 36•c,pulse 85b/m, respiration 20 b/m and blood pressure 120/80
mmHg
Her breakfast was given and drug was given

7th day
Mrs Enyinnaya woke up. Her vital signs was checked at 6:00 am and read
temperature 36•c, pulse 88b/m, respiration 20b/m and blood pressure 120/80
mmHg
Her bed was mad with neat sheet . Her drugs was given after breakfast. At
10:00am, she was reviewed by the consultant in charge of her case who made
proper analysis of the investigation was carried out on her. The investigation was
improving

8th day
Patient was discharged home after she was reviewed by the managing team her
condition was satisfactory

SUMMARY
This care study is centered on Mrs Enyinnaya Esther,a 40 year old woman with the
diagnosis of multiple sclerosis who was admitted into female medical ward of
federal medical center in Umuahia.
Good nursing and Medical care was given to her for a week spent in the hospital
Patient was advised to take medications as directed, Get regular exercise, and to
maintain a personal hygiene. She was also advised to always come for her check
up

CONCLUSION
Multiple sclerosis is favourable managed with drugs and good nursing
management which involves; Proper Observation, good hygiene, patient education.
There was no complications due to the Holistic and excellent nursing care rendered
to her.

IMPLICATIONS TO NURSING
1. It enhances and widens our knowledge in the disease condition Multiple
sclerosis.
2. It gives us in-depth knowledge on the clinical manifestation of the disease so as
to provide prompt intervention.
3. It has given us more insight on the causes of ,risk factors, pathophysiology of
Multiple sclerosis.
4. lt also gives us the idea on how to render proper nursing care on clients with this
disease condition
5. This case study has showed an in-depth knowledge about the management of
this disease using nursing care plan.
6. With the knowledge gained from this study, I can now health educate people on
this disease condition.

REFERENCE

Anderson,A.(2019). Chronic pain bladder dysfunction

Holland and Madonna,(2002). Demyelination
Rosen and Geha,(2004). Pathophysiology of multiple sclerosis
The international Advisory Committee,(2015) clinical trial of multiple sclerosis
World Health Organization,(2016). Definition and classification of multiple
sclerosis