Multiple Sclerosis Case Summary

Patient's decision-making is influenced by several factors. Patients may change their decisions, from accepting or refusing treatment depending on the available treatment options. The capacity of the individual to make informed medical decisions can differ as the patient's status changes cognitively, emotionally, and/or physically and as the proposed treatment interventions change. Treatment refusal is a common situation faced by clinicians. Patients do not usually refuse the medical advice if the advice is of good intention. When patients refuse an advice, it indicates some underlying reasons related to the patients or family, factors associated with the physician as well as social and organizational issues.

At this point in time, I feel that the patient is gravely disabled, that he cannot provide food, shelter, or clothing for himself nor make decisions in regard3 to his medical or financial affairs in his best

Gina is a 21-year old nursing student who saw her primary health care provider after experiencing episodic blurred vision, fatigue, poor motor coordination and urinary incontinence. Her neurological exam revealed mild ataxia and mild weakness in her left leg without severe spasticity. MRI scan of the brain reveals multiple plagues indicative of multiple sclerosis.

A feeding tube goes against the patient's living will. He does not have a Durable Power of Attorney for medical decisions. The patient's cognitive condition improves after a few days. When being talked to about using a gastrostomy tube for feeding, he states, "I'll go for the works." His cognitive condition continues to fluctuate making him unable to clarify what he meant by the statement.

The central nervous system (CNS) comprises grey matter, which contains neuron cell bodies and white matter, which contains the nerve axons. Most of the nerve axons are concentrically wrapped around by lipid-rich biological membrane, known as the myelin sheath. In the CNS, myelin is produced by oligodendrocyte. a type of glial cell. (Pfeiffer et al., 1993). These electrical insulating, multilamellar membranes significantly increase the electrical resistance, in which to prevent leakage of electrical currents from the axons, as well as decrease electrical capacitance to reduce the ability of the axons to store electrical energy (Shivane &

The claimant has a past medical history significant for multiple sclerosis, hypertension, gastroesophageal reflux disease, arthritis, and hyperlipidemia.

“Establishing a care plan that meets the patients’ needs and allows for appropriate interventions as symptoms change.” Patient’s without decision making ability comprise a large portion of the long term care population.” Jenna the IDT 
(interdisciplinary team) has to have continuing conversations with the patient’s family or decision maker, to help make decisions. “

• Physical ability - patient may have had a stoke and able to form words and speak normally and may have lost the ability to find the correct words or say the word due to facial muscles failing. Having other illnesses such as dementia and parkinsons, having to repeat the information

An 89 year old patient came to the emergency room from a nursing home. Per the nursing home staff, the patient had a “floppy leg” and grimaced when that leg was moved. The patient’s advance directive paperwork was provided. The patient is non-verbal. An advance directive is a document composed by competent patient’s that ensure the right of self-determination: the right of every person to make their own decisions about their medical treatment, including the right to refuse treatment (Martin, 2013).

Decisional capacity refers to the patient’s ability to perform a set of cognitive tasks including understanding and processing about diagnosis, prognosis and treatment option; weighing the relative benefits, burdens, risks of therapeutic options; applying a set of values to the analysis; arriving at a decision consistent over time and communicating the decision (Post & Blustein, 2015). Ronald does not meet all the requirements for someone with decisional capacity but this does not mean that he cannot make and specific decisions for himself at a certain time. He has fluctuating decisional capacity but on his best days, he still can dictate his care and the caregiver needs to respect that. Capacity is not global, nor is it constant. The determination of capacity can be problematic because of inconsistencies of time, physical condition at the time it was determined or the individual can manipulate results. Some critics also question pathological mental competence. Ronald, due to his age and clinical condition may demonstrate fluctuating capacity but at a certain degree can still make decisions and has the insight to do so. The caregiver and healthcare professional

James was a farmer, active every day of his life from a very early age. As a child, he helped out with the farm chores and the older her became, was more active in the daily grind of running a farm. His schedule was up before dawn and to bed by 10pm. Over the years of constant movement of his joints, James required a hip repair as the cartilage was nearly destroyed. He was 76 at the time of this first surgery and this is the identified beginning of his progressive aging. James identified himself as the provider in the family and the surgery and ensuing rehab took a hit on his ability to perform at his previous ability. Following his initial surgery, her found himself requiring surgery on the other hip and his lower back. James is seen in the clinic for follow up for evaluation of chronic pain and his functionality in everyday life. He is withdrawn and quiet; answers questions only when asked numerous times. His wife is with him and states he sleeps often throughout the day, moves about very little, and only watches TV. He

Multiple Sclerosis (MS) is a debilitating chronic disease where the immune system attacks the myelin sheaths of nerve cells in the central nervous system, affecting more than 400,000 people in the US with about 200 new cases being diagnosed each week (Pietrangelo and Higuera 2014). We still do know what causes MS and although there is no cure, there are several treatments for MS focused on slowing down the progression of the disease and managing symptoms. Although the causes of MS have not been identified, there has been much research into genetic susceptibility and exposure to environmental risk factors as well as research into how different populations manage their MS.

Peter began to suffer from complex partial seizures at the age of eight. His seizures were severe, despite taking medication he still felt pain. At the age of 20, after struggling with the condition for over 12 years, he and doctors agreed for him to undergo a commissurotomy. The commissurotomy involved a surgical incision in Peter’s corpus callosum. If any damages were done during the surgery that would have resulted in impaired communication between the two sides of the brain. It had served as a treatment for epilepsy. The surgery, was a success and it ended up attenuating the magnitude of his seizures.The negative affect was now he is unable to respond to verbal commands regarding the left side of his body. For example if someone told him

A person has been previously diagnosed with a clinical condition that causing cognitive impairments. It has been shown that they lack the capacity to make decisions.

In adult patients suffering from Multiple Sclerosis (MS), research has been done to show that in the brain, deep grey matter atrophy (damage or lesions) is measurable even within the first few years after the first attack. The neurodegenerative aspect of Multiple Sclerosis is crippling not only to the central nervous system, but to important brain substructures like the thalamus, putamen, caudate, and globus pallidus (a major part of the basal ganglia) and could lead to a hindering of brain growth in the brains of adolescents who are in critical stages of development. Researchers on behalf of the Canadian Pediatric Demyelinating Disease Network teamed together to study just that, the impact of pediatric-onset multiple sclerosis on age-expected