Question

Q:

Mr. Bennet is 60 years old. He teaches grade 5 and loves working with his students. He was diagnosed with MS at 30 years old, after many years of having symptoms. He has primary progressive MS. He enjoys teaching and hopes he will be able to continue to work in his chosen career until retirement. He is also married and has 4 young grandchildren. He is a hands-on Grandpa. He enjoys reading to his grandchildren and helping them with their homework.

Mr. Bennet has started to notice that he has some cognitive changes that are starting to occur more often. It is getting harder to pick the right word when he is talking in front of the class. This is made worse by the fatigue that hits him often halfway through the school day. He is finding that his concentration isn’t as good as it was and sometimes it is hard to stay on track during his lessons. At night he is starting to notice that his muscles are very rigid (tight like cement) and this makes it very hard to get to sleep. He no longer sleeps with his wife at night because his stiffness makes him very restless, which keeps his wife up. He is having a hard time dealing with this and the associated pain that his tight muscles are causing. His doctor explained this symptom as spasticity which is very common in people with MS. He lives in a 2-story house that he and his wife bought when they were young. The house is paid for and he has been dealing with foot drop (he drags one foot) since he had his last exacerbation (flare up) from MS. He is doing better at lifting his foot, but you can still tell there is a slight dragging of his left foot and occasionally has falls. His wife has talked about getting a chair lift (a lift that he sits down on to carry him up the stairs) installed to help Mr. Bennet on those days when he is very fatigued and he is unable to walk properly. His doctor has also talked to Mr. Bennet about getting a power wheelchair to help conserve his energy for the work that he loves so much and start doing some stretching. He has been on baclofen for the muscle spasticity for a few years and finds that the tightness is getting worse. He is also dealing with congestive heart failure, taking methyldopa for his blood pressure as well as warfarin and requires help putting on his compression stockings. His finger tips have pins and needles (paresthesia) which is making it hard for him to use his hands and he just doesn’t have the strength to get them on. He is starting to need assistance with dressing most days and his wife is dealing with her own medical problems. Mr. Bennet expressed that he is having a hard time dealing with all the changes and feels like he is a burden right now.

His goals of care are to remain as independent as possible, continue to teach, to get some cognitive therapy to help with the cognitive decline. He also requires PSWs to help him with bathing because he is quite unsteady in the shower, and the combination of baclofen as well as heat causes him to be very fatigued halfway through his shower. He has been falling in the shower and his doctor as well as his wife feels he needs some extra help.

Using all of the above information, describe the above factors that might affect Mr. Bennet from being able to be independent and allowing him to return to work for his last 5 years before retirement. Use all of the information you have in the scenario and the situations to form your answers. MS is an autoimmune disease that attacks the myelin on the axons (nerve cells) in the brain. It is a progressive disease that gets worse over time. Each individual will experience the disease differently. (6 marks)

a) Age ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

b) Individual characteristics ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

c) Environment ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Answer 1

a, age:
Multiple sclerosis affects all the ages. it is the neurological progressive disease that affects the CNS. It affects mostly 20 to 50 years. The onset of MS occurs in 30years. when aging progress it affects their motor and cognitive function. Age-related changes affect the brain and neuronal viability and vulnerability.
b, Individual character:
Multiple sclerosis in progress in later age it affects the brain and damages the cognitive function. patient feeling extreme fatigue, lack of coordination, tingling, weakness, loss of sensation, cognitive changes. they have negative outcomes and depression with their poor outcomes that affected their personality. Patient needs independent life but his MS made him not able to live independently. Individual character affects with lack of relationship, social and family support, self- efficacy.
c, environment:
the stress increase MS symptoms. when patient is with MS they have to avoid excess stress as much as possible and have to follow healthy lifestyle and adequate rest. The patient is working as a teacher his stress level affected his neuro system and the patient started to have fatigue, cognitive changes and increase with burdensome symptoms.