Walden – NURS 6521 – Neurologic and Musculoskeletal Disorders

What’s Coming Up in Module 5?

In the next module, you will examine diagnoses for patients with neurologic and musculoskeletal disorders, and you will complete your Midterm Exam.

Looking Ahead: Midterm Exam

Please review the Resources and content in the previous modules in preparation for your Midterm Exam in Module 5.

Next Week

To go to the next week:

Module 5

Module 5: Neurologic and Musculoskeletal Systems

What’s Happening In This Module?

Module 5: Neurologic and Musculoskeletal Systems is a 2-week module, Weeks 6 and 7 of the course. In this module, you will analyze drugs prescribed to treat neurological and musculoskeletal disorders and explore patient education strategies for treatment and management of these disorders. You will also evaluate the impact of patient factors on the effects of prescribed drugs and drug therapy plans for neurologic and musculoskeletal disorders. You will also complete your Midterm Exam.

Go to the Week’s Content

Week 6

Week 7

Week 6: Neurologic and Musculoskeletal Disorders

Sabrina is a 26-year-old female who has just been diagnosed with multiple sclerosis. She has scheduled an appointment for a follow up with her physician but has several questions about her diagnosis and is calling the Nurse Helpline for her hospital network. As she talks with the advanced practice nurse, she learns that her diagnosis also impacts her neurologic and musculoskeletal systems. Although multiple sclerosis is an autoimmune disorder, both the neurologic and musculoskeletal systems will be affected by adverse symptoms that Sabrina needs to be aware of and for which specific drug therapy plans and other treatment options need to be decided on.

As an advanced practice nurse, what types of drugs will best address potential neurologic and musculoskeletal symptoms Sabrina might experience?

This week, you will evaluate patients for the treatment of neurologic and musculoskeletal disorders by focusing on specific patient case studies through a decision tree exercise. You will analyze the decisions you will make in the decision tree exercise and reflect on your experiences in proposing the recommended actions to address the health needs in the patient case study.

Learning Objectives

Students will:

Evaluate patients for treatment of neurologic and musculoskeletal disorders

Analyze decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders

Justify decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders

Learning Resources

Required Readings

• Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2^nd) St. Louis, MO: Elsevier.
• Chapter 11, “Basic Principles of Neuropharmacology” (pp. 67–71)
• Chapter 12, “Physiology of the Peripheral Nervous System” (pp. 72–81)
• Chapter 12, “Muscarinic Agonists and Cholinesterase Inhibitors” (pp. 82–89)
• Chapter 14, “Muscarinic Antagonists” (pp. 90-98)
• Chapter 15, “Adrenergic Agonists” (pp. 99–107)
• Chapter 16, “Adrenergic Antagonists” (pp. 108–119)
• Chapter 17, “Indirect-Acting Antiadrenergic Agents” (pp. 120–124)
• Chapter 18, “Introduction to Central Nervous System Pharmacology” (pp. 125–126)
• Chapter 19, “Drugs for Parkinson Disease” (pp. 127–142)
• Chapter 20, “Drugs for Alzheimer Disease” (pp. 159–166)
• Chapter 21, “Drugs for Seizure Disorders” (pp. 150–170)
• Chapter 22, “Drugs for Muscle Spasm and Spasticity” (pp. 171–178)
• Chapter 59, “Drug Therapy of Rheumatoid Arthritis” (pp. 513–527)
• Chapter 60, “Drug Therapy of Gout” (pp. 528–536)
• Chapter 61, “Drugs Affecting Calcium Levels and Bone Mineralization” (pp. 537–556)

American Academy of Family Physicians. (2019). Dementia. Retrieved from http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=5

This website provides information relating to the diagnosis, treatment, and patient education of dementia. It also presents information on complications and special cases of dementia.

Required Media

Laureate Education (Producer). (2019b). Alzheimer’s disease [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat Alzheimer’s disease.

Laureate Education (Producer). (2019e). Complex regional pain disorder [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat complex regional pain disorders.

Disorders of The Nervous System

Reflect on the comprehensive review of disorders of the nervous system and think about how you might recommend or prescribe pharmacotherapeutics to treat these disorders. (15m)

Sample Paper Week 6

Walden NURS 6521 – Neurologic and Musculoskeletal Disorders

Multiple Sclerosis

Student’s Name:

Institutional Affiliation

Multiple Sclerosis

From the case study, Sabrina is a 26-year-old female patient who was diagnosed with multiple sclerosis. The patient booked an appointment with her physician for the management and treatment of the condition. Sabrina presents several questions concerning her diagnosis. As such, she calls the nurse helpline for her hospital network. She notes that multiple sclerosis affects her musculoskeletal and neurologic systems upon talking to the physicians. She learns that although the condition is an autoimmune disease, its symptoms and signs can affect other functions. Therefore, Sabrina should be aware of the specific drug therapy and other options of treatment that her physicians could decide to administer.

Symptoms of the Disorder

Signs of multiple sclerosis may vary from person to person. Typically, the symptoms affect movement functions. They include weakness or numbness in the limbs, which mostly touch one side of the patient’s body at a time. The numbness may affect the trunk and the legs of the patient (Claes et al., 2014). Another symptom of the disorder in the electric shock sensation which occurs when the neck makes specific movements. It happens especially when the neck bends forward. Also, patients of multiple sclerosis experience unsteady gait, lack of coordination, and tremors.

Decision Tree

Multiple sclerosis has no actual cure. As such, treatment aims at speeding up the recovery process from the attacks, management of the MS signs and symptoms, and slowing the progression of the disease (Claes et al., 2014). Some patients have very mild signs, so that no treatment is necessary.

Treatment Decision for MS Attacks

Medications knowns as corticosteroids, which include oral prednisone and IV methylprednisolone, are administered to minimize the effects of nerve inflammation. However, these drugs have side effects such as mood swings, fluid retention, and insomnia. Plasmapheresis (plasma exchange) is another option for the treatment of MS attacks (Spencer et al., 2015). The liquid part of the blood is removed and isolated from the blood cells. The blood cells should then be mixed with albumin and put back into the body. This decision is made when the symptoms are severe, and they have failed to respond to the corticosteroids.

Treatment Decision to Reduce Progression

The physician may also decide to give a prescription to modify MS progression. Disease-modifying therapy (DMT) is given the MS patients to slow down the rate of progress. Treatment choices for relapsing-remitting MS are composed of different intravenous medications (Spencer et al., 2015). Glatiramer acetate medication helps to block the patient’s immune system from attacking myelin. The drug is usually injected below the skin. Beta interferons are also commonly administered to reduce the severity and frequency of relapses.

Treatment Decision for Signs and Symptoms

Another treatment decision for the MS should aim at relieving the symptoms. Physical therapy can help the patients to relax the muscles through stretching and strengthening exercises (Stangel et al., 2015). Muscle relaxants such as tizanidine (Zanaflex) are useful in alleviating the uncontrollable muscle pain, spasms, and stiffness.

Sabrina’s Treatment Decision

For Sabrina’s case study, the treatment decision was aimed at the reduction of progression. Sabrina is a young patient who was diagnosed with early symptoms of MS. The DMT therapy would ensure that the disease progression would be slightly lower than the untreated cases. Also, the treatment option given to Sabrina ensures that the relapse rate and the formation of lesions are reduced.

Differences between Actual and Expected Results

The decision to treat MS attacks is expected to reduce the effects of nerve inflammation. However, the actual outcome may differ from the anticipated results due to the side effects of the drugs, which include flu-like symptoms. Also, the treatment option to reduce progression is expected to reduce the rates of relapse (Stangel et al., 2015). However, the actual results may vary due to side effects such as blurred vision and nausea.

References

Claes, N., Dhaeze, T., Fraussen, J., Broux, B., Van Wijmeersch, B., Stinissen, P., … & Somers, V. (2014). Compositional changes of B and T cell subtypes during fingolimod treatment in multiple sclerosis patients: a 12-month follow-up study. PLoS One, 9(10), e111115.

Spencer, C. M., Crabtree-Hartman, E. C., Lehmann-Horn, K., Cree, B. A., & Zamvil, S. S. (2015). Reduction of CD8+ T lymphocytes in multiple sclerosis patients treated with dimethyl fumarate. Neurology-Neuroimmunology Neuroinflammation, 2(3), e76.

Stangel, M., Penner, I. K., Kallmann, B. A., Lukas, C., & Kieseier, B. C. (2015). Towards the implementation of ‘no evidence of disease activity’ in multiple sclerosis treatment: the multiple sclerosis decision models. Therapeutic advances in neurological disorders, 8(1), 3-13.

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