Question

You should aim to answer these questions as part of your ISBAR handover:

1. What is the pathophysiology of the client’s current condition(s)? What is your assessment of the client’s current medication including pharmacology and pharmacokinetics?

2. Consider the patient/collect cues- what information do you have?

3. Assessments required- What further information do you need or would like prior to your visit?

4. Identify problem/Issue- why are you visiting them? What will you do once there?

5. Establish Goal- What is it that you aim to achieve through your care and how will you undertake the care required?

6. Evaluation- what strategies will you use to evaluate the outcomes?

case study:

Patient 4: Estimated consult time 2-3hrs

Mrs. Rebecca Smyth

Street address: 118 The Boulevarde, Lewisham. NSW

Age 44

Medical History: Relapsing – Remitting Multiple Sclerosis (RRMS) diagnosed three years ago.

Current medical history: Symptoms of spinal syndrome characterised by paraesthesia, pain, muscle spasms and spasticity. Muscle weakness and stiffness in her limbs Increasingly experiencing pain and fatigue Sense of hopelessness. Impaired vision which makes reading more difficult Diplopia which affects her balance. Slurred speech

Social History: Rebecca lives with her husband Jim in a ground floor apartment. They have one daughter, Tiffany, 8 years old. Jim runs the family plumbing business from home but is often out on the road. Rebecca left her position as a customer relations officer with Westpac and is trying to maintain the books for Jim’s business. House has overgrown front yard and 3 broken steps to the front door.

Current medication: Baclofen 5 mg TDS Diazepam 5 mg nocte Trial of Gabapentin 300 mg mane

Current issue being managed: Pain management and increase in symptomology

Answer 1

1)ans)Pathophysiology of the client's current condition:

following are the steps of pathophysiology

A)Multiple sclerosis easy and immune mediated inflammatory disease that attacks myelinated axons in nervous system.

B)Destroying the myelin and the axon in variable degree and producing significant physical disability.

C)(Oligodendroglia cells produce myelin cell in CNS).

Inflammation, neurodegeneration (produced by damaged mitochondria).

D)CNS tissue damage (axonal damage).

E)Fibrous gliosis developing plaque that are disseminated through the CNS.

F)Lead to lateral and posterior clomns ,optic nerve and periventricular areas are damaged.

G)Inflammation of the retinal vascular endothelium nerve.

H)Diplopia,slurred speech.

I)Grey matter in the cerebrum and spinal cord also affected.

J)Paraesthesia, muscle weakness,pain.systems occurs when disease progression.because degeneration of myelin sheath.

2)ans)baclofen:

It's used as CNS depressants and skeletal muscle relaxants.

Treat spasticity.

The drug is rapidly absorbed after oral administration why the distributing throughout the body.

Chemically it is a derivative of the neurotransmitter aminobutric acid (GABA).

Work by activating GABA receptors to block mono and poly synaptic reflexes by acting as an inhibitory neurotransmitter.

Half life of baclofen is roughly 2_4 hours.

gabapentin 300mg:

It is absorbed slowly after oral administration,with maximum plasma concentrations attained within 3-4 hours.

It's eliminated from the systemic circulation by renal excretion as unchanged drug.

2)ans) patient suffering with RRMS: based on patient clues and symptoms:

RRMS: characterized by periods of neurological worsening following by the remissions.which patient's have relapses of MS and periods of stability in between relapses.

Younger patient are more common to have this form of MS than older persons.

MS is a chronic,immune mediated disease...I.e, immune system abnormally targets and attacks parts of brain and spinal cord.two or more attacks,called relapses,are usually followed by partial or complete recovery.

3) assessment needs prior to visit the client :

I need ,a family history of client.

Lab investigations include :blood ,urine analysis,MRI.

Dietary habits.

4)and) identifed problems faced by the patient:

1)muscle weakness as evidenced by unable manage house work.

2) pain is related to disease process as evidenced by facial expressions.

3) activity intolerance is related to instead gait as evidenced by observation.

4) impaired physical mobility is related to weakness or Paraesthesia.

5)self esteem disturbance is related to disease progression.

6) impaired skin integrity is related to decreased mobility.

7) impaired bowel and bladder pattern.

8) visual disturbances related to retinal nerve damage.

5)ans) goals:

To provide psychological support.

To maintain skin integrity.

To Provide regular exercise.promote physical mobility.

To provide bladder and bowel control.

To Improve sesory and cognitive function.

care:

promote physical mobility,development of coping mechanisms,walking and gait excercise.improve self care,improve hydration and nutrition.

6)ans) evaluation:

Patient free from symptoms.

Developed psychological support.

Maintain well balanced gait by using support.

Improved physical mobility.

Maintained bowel and bladder control movement.

Improved speech by speech therapist.

Developed coping strength.