Case Study - Multiple Sclerosis
Case Study - Multiple Sclerosis
1. CASE AUTHORS
Name
Department of Nursing – NP Programs
Phone
FAX
Name
Department of NP
Phone
FAX
6. TIME ALLOTTED FOR ENTIRE TASK (includes SP/examinee encounter + interstation activity):
FIFTEEN MINUTE STATION W/SP + 5 MIN INTERSTATION
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Case Study: Adult with Multiple Sclerosis
8. FACILITY/ROOMS RESERVED FOR THIS ACTIVITY:
[X] Clinical Learning Lab/ SP Rooms [X] Seminar Rooms
[X] Auditorium [X] Campus
[X] Other:
9. INTERACTION FORMAT:
Participants
[X] With SP Feedback [X] With Videotape
[X] 1 Trainee, 2 SP (1 Adult and 1 Adolescent)
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Case Study: Adult with Multiple Sclerosis
15. PHYSICAL FINDINGS THE SP SHOULD NOT HAVE:
N/A
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Case Study: Adult with Multiple Sclerosis
STANDARDIZED LIFE SKETCH
19. What do you want the SP to say to the examinee's first query:
SP: “There is so much going on with my family, I need to get checked out.”
20. IF THE EXAMINER REMAINS SILENT, or acts as if waiting for more information, or asks an
open-ended question:
SP: “I’m really nervous, my little sister was diagnosed with breast cancer a few months ago and I haven’t
had a mammogram or GYN exam in YEARS.”
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Case Study: Adult with Multiple Sclerosis
IF THE EXAMINER ASKS, SP RESPONDS TO THE FOLLOWING QUESTIONS:
Insomnia:
SP: “Yes.”
Fatigue:
SP: “Yes.”
Pain anywhere else:
SP: “No.”
Changes in vision:
SP: ”Yes, increasingly blurry.”
Self breast exams:
SP: “No.”
Sexual activity:
SP: “Yes. I am in a monogamous relationship.”
Last menstrual period:
SP: “2 weeks prior.”
Bowel patterns:
SP: “No change, use suppository every 3 days or so for chronic constipation.”
Appetite:
SP: “Poor secondary to pain.”
Bladder problems:
SP: “Straight caths 3x day but becoming tougher because of loss of dexterity.”
Musculoskeletal/Neuro:
SP: “Increasingly difficult to transfer by herself and cannot stand without assistance.”
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Case Study: Adult with Multiple Sclerosis
22. IF THE EXAMINER ASKS about exercise:
SP: “I go to PT 2 days a week when my insurance company will pay for it.”
IF THE EXAMINER ASKS: “How long have you been in a wheelchair?”
SP: “I would guess it has been all the time for about 4 years.”
23. Psychosocial consequences: How does the problem influence or affect the pt?
IF THE EXAMINER ASKS:
SP: “It is really frightening…first the MS now this scare.”
24. Response to symptoms: What has the patient done about the symptoms (other than seeking health care)?
IF THE EXAMINER ASKS:
SP: “I just keep trying.”
25. Meaning of the illness: patient's ideas/feelings about causes, implications, fears about problem/illness?
SP: “I wouldn’t wish this on my enemies.”
27. Surgical:
Right THA (2009)
Implantable Pain Pump (2011)
Colposcopy-no dysplasia (2005)
29. Allergies:
SP: “None that I know of.”
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Case Study: Adult with Multiple Sclerosis
30. Medications:
MVI 1 po qd
Calcium with D 600/400mg 1 po q 12h
Boniva 150mg po q month
Baclofen pump (per pain management) 400mcg IT qd
Gabapentin 200mg po q8hrs
Copaxone 20mg sq qd
Senna tabs 2 tabs po q12hrs
Miralax 17g po qd
Estradiol/norethindrone 0.5/0.1mg 1 po qd
Straight caths for self caths q8hrs
D. FAMILY HISTORY:
31. Current and past health of parents, sibs, adolescent:
Mother: alive, 69yo, breast cancer 2009
Father: alive, 70yo
Sister: 38yo breast cancer 2011
Son: 13yo. No health issues
E. PSYCHOSOCIAL HISTORY
Present/Past:
38. Significant events in pt's life: stresses, pleasures, death, divorce, financial hardships?:
I spend a lot of time home alone, busy with my son and helping organize his life. Thank goodness for my
parents. Unemployed. Unable to drive. Gets social security disability plus help from her ex-husband.
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39: Employment:
Unemployed
43. Anxiety?
Yes.
47. Other?
No.
G. FUNCTIONAL STATUS:
49. Pt able to take care of daily activities? (school, dressing, washing self?)
SP: “I can but I need more and more help because it is all just so hard and I am so slow.”
H. OTHER:
50. Other than HPI, any other medical/psychosocial problems the pt is currently facing?
SP: “No.”
52. Patient expectations: what does the patient expect/want from health care provider?
SP: “Help getting tests done.”
Case Study: Adult with Multiple Sclerosis
Development of this content was partially supported by a grant from HRSA (D09HP18998-01-00). 8
53. Adolescent SP Appearance: clothing, grooming, etc. (ex: neat, disheveled, in hosp. gown, etc., or: clothing
and/or appearance unimportant to the case)?
Fully dressed in wheelchair neat and well put together.
54. Affect/Behavior: body language, mannerisms, eye contact, angry, sad, talkative, nervous, happy to see NP
today?
Anxious.
55. Do any questions posed by the examinee change the SP's appearance or affect (disturb either of the SPs or
make either sad, fearful, reassured)?
No.
56. Creating empathic opportunities: what do you want the SP to say, or what kind of behavior would create an
opportunity in this case, for the examinee to express empathy?
You are right. Your sister is young and combined with your family history, you have a right to be
concerned.
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Case Study: Adult with Multiple Sclerosis
SKILLS PERFORMED
1) Addresses patient
2) Assists patient into gown and onto exam table
3) Takes adequate health history
4) Inspects pt head to toe
5) Completes following exams:
a. Neuro
b. Cardiac
c. Respiratory
d. Breast
e. Abdomen
f. Musculoskeletal
g. Skin
CONTENT CHECKLIST
Category 1. Data gathering. I TOLD THE EXAMINER or /THE EXAMINEE ASKED ABOUT:
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Case Study: Adult with Multiple Sclerosis
SKILLS CHECKLIST
I. DATA GATHERING SKILLS
Did the examinee …
1) Provide a safe environment for the adolescent?
2) Allow the SP to finish opening statement without interruption?
3) Get the chronology of the present concern from the beginning until now?
4) Use “open-to-close cone” question style?
5) Repeat or summarize information I’ve given at least once?
V. PATIENT SATISFACTION
13) Overall, I was satisfied with this NP/patient interaction
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