Effective Care For Patients With Multiple Sclerosis: Miller’s Theory Of Functional Consequences And Clinical Reasoning Cycle

Background Information

Miller’s theory of functional consequences as well as clinical reasoning cycle are important theories that aid nurses in clinical decision making and thereby provide effective care to the patent ensuring patient satisfaction (Hacolaski et al., 2016). This assignment would show how these two theories can guide nurses in provide safe and quality care. A patient with Multiple sclerosis (MS) would be treated, where nurses would be helping him to develop his gait and mobility to live quality life.

Mr Dinh Nguyen is an 83-year-old widower. He has a history of Multiple Sclerosis (MS) that affected him six years ago. Again, four years ago, he was diagnosed with osteoarthritis but the situation is under control due to medication. He lives alone in his house and his financial condition is such that it only covers his expenses not allowing him to maintain a better quality life. Presently he is suffering from ill health mainly due to the ongoing worsening exacerbations of his Multiple sclerosis (MS).

The patient had been suffering from ongoing exacerbation of Multiple sclerosis (MS). It had accompanied with blurred vision, numbness in the face as well as electric shock when he tries to move his head or neck. The electric shock is seen to travel through his legs and back that is affecting his gait and movement. These are affecting his daily activities like showering, cooking as well as dressing difficult for him. He is quite concerned about the loss of his abilities as he stays alone and is no one to help him in such situations.

The disorder of Multiple sclerosis (MS) can be explained as the potentially disabling disorder of the brain as well as the spinal cord. In this disorder, the immune system of the patients are seen are seen to attack the protective sheath called the myelin and this causes communication issues between the different parts of the body and the brain. This results in the deterioration of the condition of the nerves or might also be permanently damaged. Signs and symptoms of the disorder mainly depend on the intensity and the extent of the damage that had taken place in the nervous systems (Rahn et al., 2018). The symptoms that the patient named Dinh is experiencing totally correlates with the symptoms of the multiple sclerosis as is found from the different evidences based studies. Patients suffering from Multiple sclerosis (MS) is seen to experience numbness as well as weakness in one or more limbs that are mainly seen to occur at one side of the body at a time or also in the legs and the trunk. The patient in the case study has stated of his issues he faces in his legs that had resulted him in suffering from mobility issues. Loss of vision also takes place in the disorder and the patient also experiences blurry vision showing that Multiple sclerosis (MS) in affecting him intensely. The patient feels electric sensations during neck movements especially during the time of bending and Dinh complains of similar issues. The patient is seen to live alone and suffers from grief and loneliness after the death of his wife. He is facing isolation from the rest of the society due to the conditions of impaired mobility and blurred visions (Moss-Marris et al., 2016). As a result, there is a high chance that long periods of grief and isolation might make him depressed. Financial constraints are also seen to occur as he downs not have enough money required for quality living. Poor mental health condition would contribute to further worsening of not only his physical health but also affect the quality of his life.  Third, he is not being able to conduct the daily activities of his life in a smooth fashion. Restricted ability of his movements has created a barrier in cooking, showering as well as dressing difficult. He is facing difficulty in bending and tying his shoe knots as well. This might affect his regular diet and timing of the diet, as he might not be able to cook food and eat them in correct amount and right time (Reen, Silber & Langdon, 2017). As he cannot shower properly, he might develop skin irritations and develop improper skin hygiene if he misses bathing and showering because of the pain. He is also having urine incontinence and therefore, it would become more difficult to handle such situations and the effects. All these would lead to the situation where he would be having very poor quality life and would be suffering heavily due to his self-care deficits.

Patient Profile and Symptoms

From the entire discussion above, it becomes clear that three important nursing priorities need to be care by the nursing professionals. The first one is to help him develop better stability while working and assessing the different risk factors associated with falls. The patient had lost stability n his gait and movement and has mobility issues. Hence, this arena should be cared by the professionals to prevent his chances of fall (van den Akker et al., 2017). Secondly, he is filled with grief due to his loneliness and separation from his wife after her death. He is gradually losing independence in different daily activities of his life and his financial condition so not stable enough to support anything other than his expenses. Therefore, his mental health condition should be also cared for as he might develop depression. Third, he has lost all abilities to conduct daily activities of living like showering, cooking, dressing and others. This might affect his quality of life resulting in missing of meals, development of skin issues and improper hygiene and others (Iamhoff et al., 2015). Therefore, his self-care deficits should be taken as important zone for intervention and nurses should care for him accordingly.

Miller had developed the functional consequences theory in the year 2004 where he had clearly stated that older adults experience functional consequences because of different types of age related changes as well as additional risk factors. Without any proper interventions, many functional consequences turn out to be negative which if not taken care might result in poor quality life and different disabilities (Straus, 2017). Therefore, this theory advises the nursing professionals to identify the factor that causes negative functional consequences and thereby help in initiating interventions that help in providing positive outcomes. This theory supports and encourages the nursing professionals for helping the aging person to experience the health fulfillment and thereby develop a sense of well being. It is the duty of the nurses to be aware whether the changes that are affecting the patients are because of the aging as well as diseases condition (Miller, 2018).

Therefore, it is very important for the nurses to identify that of the most important concern like that of the loss of the ability of the movement in the patient is because of disorder r due to aging. By applying this theory, it is identified that the loss of the ability of the patient in his mobility is mainly because of the exacerbation of the disorder of Multiple sclerosis (MS). Movement of the normal individuals mainly takes place as result of the coordinated as well as efficient muscle contraction where necessary muscles, nerves, joints all act together (Gu et al., 2015). The coordination of the muscle mainly takes place because of the integrated nervous systems, brain, skeletal and spinal cord functions. Along with it, cerebellum is seen to process the information that helps in allowing the more fine-scale, precise movements. However, in case of the Multiple sclerosis (MS), messages are not transmitted properly. This is mainly because the paths between the rain, as well as the spinal cord and the muscles get damaged. Because of this, the messages get scrambled and therefore, several muscle groups are seen to contract at the same time when they should not do so. Researchers are of the opinion that because of this reason, precise more control is lost progressively. Simultaneous contraction of the flexor as well as the extensor muscles are seen to lead to a lack of coordination that associates with painful and debilitating results (Norman et al., 2017). Loss of mobility is mainly results from the progressive degradation of the myelin and hence of the different nerve fibers. This causes disruption of the transmission of the nerve signals to the muscles that helps in mobility. Therefore, these muscles do not get the appropriate orders to contract. Damage occurring in the upper motor neurons (that control the reflexes and muscle tone) results in generating continuous muscles contraction. These affect the joint reflex. Hence, the nursing professionals after indentifying that the loss of mobility is due to disorder and not due to aging, they need to take effective steps to ensure that the old patients lives quality life according to Miller’s functional consequences theory (Deschênes & Goudreau, 2017).

Nursing Priorities

The main goal of the treatment would be the maximization of the quality of the life of the patient mainly by managing the different symptoms, shortening of specific exacerbations and thereby ensuring slowing of the progression of the disorder. The main goals would be managing his mobility issues so that he can develop a stable gait, conduct his daily activities, gain some degree of independence and can interact with society, friends and families and overcome the feeling of isolation.

Immunotherapy treatments should be initiated and maintained which would help in slowing down the frequency as well as the severity of the patient. Researchers often state corticosteroids to be used that help the individual from recovering from Multiple sclerosis (MS). Physicians can also advise for different medications like muscle relaxants according to the degree and intensity of the condition of the patient. One of the most important interventions that nurses should also conduct is the arrangement of physiotherapists along with other medications that would help in the treatment of the muscle problems (Lubarsky et al., 2015). These would help in the easing out of the spasms, stiffness and tremors. The professionals would also help in providing exercise programs. This will improve the strength, balance as well as coordination and flexibility of the individual. Occupational therapists should also be referred, as they would help the patient to learn energy saving skills that might be with the use of aids and help the patient to learn coping strategies to manage fatigue and ensure conducting of activities of daily lives smoothly. The nursing professionals also might help the patient by suggesting the use of different aids like canes, crutches, walkers and/or wheelchairs. Proper fall risk management should be also done (Elven et al., 2015). This would include removal of clutters from the floor of his house, attaching bed rails, bathroom bars, proper lighting of his house, not wearing of too loose clothes and many others. Wearing of non-skid slippers and many others should also be done. This would help in development of mobility of the patient and prevent chances of fall.    

Banner Mobility Assessment Tool for Nurses: Instrument Validation was used for the patient. It was seen that the patient scored well although he was not entirely stable but condition was seen to be improving. Because of this reason, the treatment plan was continued and gradually the person developed gait and stability in his movements (Balsley et al., 2015).

Miller’s Theory of Functional Consequences

The patient was assessed and it was realized that mobility issues were not due to aging problems but because of Multiple sclerosis (MS). Hence, I had successfully indentified it and provided intervention that helped in caring for the most important need and requirement of the patient. Loss of mobility was the main reason that had not only affected his daily activities but had also made him isolated and depressed. Accordingly, effective care interventions were given which helped him to develop better quality lives. The care and communication that were done were designed according to his cultural preferences and this satisfied him to a great extent.

From the above discussion, it was seen that the patient was suffering from his mobility issues that were affecting his daily activities. Therefore, with the help of Miller’s theory, it was identified that this issue as because of Multiple sclerosis (MS) and not due to aging. With the help of the clinical reasoning cycle, symptoms were identified, care priorities were developed and accordingly care was given to the patient.

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