Competency Appraisal

You have been asked to see D.V. in the neurologic clinic. D.V. has been referred by his internist, who thinks his patient is having symptoms of multiple sclerosis (MS). D.V. is a 20-year-old man who has experienced increasing urinary frequency and urgency over the past 2 months. Because his female partner was treated for an STD, D.V. also underwent treatment, but the symptoms did not resolve. D.V. has also recently had 2 brief episodes of eye fuzziness associated with diplopia and brightness. He has noticed ascending numbness and weakness of the right arm with inability to hold objects over the past few days. Now he reports rapid progression of weakness in his legs. 1. MS is an inflammatory disorder of the nervous system causing scattered, patchy demyelinazation of the CNS. What does myelin do? What is demyelinization? 2. MS is characterized by remissions and exacerbations. What happens to the myelin during each of these phases? 3. Isnt D.V. too young to get MS? What is the etiology? 4. What assessment data from the case study caused the physician to suspect a possible diagnosis of MS? 5. What are four common diagnostic tests you can begin to teach D.V. about? 6. D.V. asks you. If this turns out to be MS, what is the treatment? 7. As part of your teaching plan, you want D.V. to be aware of situations or factors that are known to cause an exacerbation of symptoms. List four.

D.V. confides in you that he tried to commit suicide at the age of 14 when his parents got a divorce. He tells you that he knows his girlfriend hasnt been faithful, but hes afraid of living alone. He admits that she occasionally hits him, but hes afraid if he tells her about his M.S. diagnosis, shell leave him for good. You recall seeing yellowish bruises on his arms when you took his admission BP. 8. What are you going to do with this information? 9. In view of his personal history and current diagnosis, what two critical psychosocial issues are you going to monitor for in his follow-up visits?